SOAP NOTE Presentations Dot Phrases MDM

[[TODO]]	
HP	
Date of Note:	
Chief Complaint:	
History of Present Illnesses:	
Past Medical History:	
Allergies:	
Medications:	
Past Surgical History:	
Social History:	
[[ROS (Review Of System(s))]]: as above	
Family History:	
[[PE (Physical Exam(ination))]]:	
Vital Signs	
Temp / HR / RR / BP / O2 Sat	
/ / / /	
GEN: NAD, Laying Comfortably in bed	
HEENT: PERRLA, no jaundice	
CV: rrr, no mrg, +S1, S2	
PULM: CTAB, no crackles, [[Wheez(-e -es; -ing)]], rales	
ABD: soft, NTND, no rebound, no guarding	
EXT: 2+ peripheral pulses. No edema b/l.	
SKIN: no petechiae, no rash	
NEURO: A&O x 3.	
GU/Pelvic/rectal: deferred	
Test Results:	
Labs	
BMP	
Na / K / Cl / [[HCO3- (Bicarbonate (22-28 mEq/L))]] / BUN / Cr < Glu	
/ / / / / <	
CBC	
WBC > Hgb / Hct < Plts	
> / <	
LFTs	
Albumin / Tot Protein / D. Bili / T. Bili / AST / ALT < [[ALP (Alk-Phos; Alkaline Phosphatase)]]	
/ / / / / <	
IMAGING	
Assessment and Plan:	
yo M/F with PMH * presents with	
# FEN/GI: regular diet	
# [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]] PPX: [[Heparin]] [[SubQ (Subcutaneous)]]	
# Code Status: FULL CODE	
# Dispo: Pending medical work-up	
# Emergency Contact:	
[ ] [[Central Line]], [[PICC (Peripherally Inserted Central Catheter)]], or dialysis catheter present and indicated	
PLEASE SEE ATTENDING ADDENDUM	
DISCUSSED WITH DOCTOR: Dr. Richman	
Used Interpreter - Name:	
Used HCN - Interpreter ID #:	
Interpretation language:	
ABD Reassessment	
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]].	
AMA	
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.	
Discharge	
Pt well appearing, nontoxic, af, HDS. Patient advised of exam and study findings Patient understands and agrees with the plan of discharge. Return precautions discussed. Patient verbalized full understanding. Patient comfortable going home.	
EKG Normal	
EKG: [[Normal Sinus Rhythm]], no TWI/ST changes, normal intervals, ***normal axis.	
EKG syncope	
EKG reviewed, no TWI/ST changes. No [[Dysrhythmia]]s. Low suspicion for [[WPW (Congenital Pre-Excitation Syndrome; Wolff-Parkinson-White)]], [[QT Interval (Segment) Prolongation]], [[HOCM (Hypertrophic Obstructive Cardiomyopathy)]], [[Brugada Syndrome]].	
ETOH reassess/discharge	
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient with increased lucidity, tolerating PO, interactive with staff. [[Hemodynamic(ally) (Stability, Stable)]].	
Trialed gait after several hours of observation in the ED with improvement in mental status to baseline and with stable gait. Cautious return precautions discussed w/ full understanding.	
FAST Neg	
FAST negative: Cardiac motion present. No pericardial fluid . No free fluid RUQ, LUQ or in pelvis.	
Headache	
Patient headache has improved after medication. No focal neurological deficits.	
Reassess	
Patient reassessed and re-examined. No additional findings on exam or complaints. Pt well-appearing.	
Signout	
Patient Signed out to Dr.	
Pending items	
Likely dispo	
ALLERGIC RASH – LOW RISK	
This patient presents with symptoms consistent with acute [[Hypersensitivity]] reaction, likely acute allergic reaction. Presentation not consistent with acute [[Anaphylaxis]] (lack of pulmonary, dermatologic, cardiovascular or GI symptoms, lack of [[Hypotensive]] or exposure to known allergen), [[Angioedema]], [[Serum Sickness]] (no recent drug exposure, lacks fevers, arthralgias), ingestion of [[Preformed Toxin]]. No evidence of airway compromise or shock at this time. Plan to treat for an allergic reaction with H1/[[H2 Blocker]], [[Steroid]]. No indication for [[Epinephrine (Adrenaline)]] at this time.* Given lack of respiratory symptoms, no indication for EpiPen Rx.*	
Plan: ***H1/[[H2 Blocker]], [[Steroid]], close [[Hemodynamic Monitoring]], serial reassessment	
[[AMS (Altered Mental Status)]] – GENERAL	
This is a @[email protected] @[email protected] presenting with [[AMS (Altered Mental Status)]], concerning for *. The differential includes toxic metabolic etiologies such as [[Electrolyte Disturbance]]s (Na/Ca), [[↓Glucose↓]], and [[Uremia]]; acidosis states, infection (i.e. Sepsis); toxidromes of intoxication or withdrawal, [[PO2 <8 kPa (Hypox(a)emia)]] or [[Hypercarbia]], [[Liver Disease]] or failure causing [[Hepatic [[Encephalopathy (Altered (Level Of) Consciousness)]]]], endocrine emergencies (hyper/[[Hypothyroid(ism)]], [[Hypoadrenalism ((Acute; Severe) (Adrenal Insufficiency; ((Addisonian; Adrenal) Crisis))]]), seizure, trauma, intracranial bleeds or [[Ischemic Stroke]]. Given this wide differential, will send basic labs and lytes to evaluate for metabolic causes, FSBS, LFTs,, TSH, *CT head, *[[Blood Gas]]. *LP?/abx?	
AMA DOCUMENTATION	
This patient has elected to leave [[AMA (Against Medical Advice)]]. In my opinion, the patient has capacity to leave AMA. The patient is clinically sober, free from distracting injury, appears to have intact insight and judgment and reason, and in my opinion has capacity to make decisions. I explained to the patient that his symptoms may represent *** and the patient verbalized understanding of my concerns.	
I had a discussion with the patient about their workup and results, and that they may still have * despite *. I informed the patient that the next step in diagnosis and treatment would be *, and they verbalized understanding of this as well. I explained the risks of leaving without further workup or treatment, which included reasonably foreseeable complications such as death, serious injury, permanent disability, and *. I also offered alternatives to departing AMA such as assigning the patient a different provider or an alternate workup pathway.	
The patient is refusing any further care, specifically *, and is leaving [[AMA (Against Medical Advice)]]. I am unable to convince the patient to stay. I have asked them to return as soon as possible to complete their evaluation, and also explained that they were welcome to return to the ER for further evaluation whenever they choose. I have asked the patient to follow up with their primary doctor as soon as possible. I have answered all their questions. Patient signed*did not sign AMA paperwork.	
AMA DOCUMENTATION	
MDM	
This patient has elected to leave against medical advice. In my opinion, the patient has capacity to leave AMA. The patient is clinically sober, free from distracting injury, appears to have intact insight and judgment and reason, and in my opinion has capacity to make decisions. I explained to the patient that his symptoms may represent *** and the patient verbalized understanding of my concerns.	
I had a discussion with the patient about their workup and results, and that they may still have * despite *. I informed the patient that the next step in diagnosis and treatment would be *, and they verbalized understanding of this as well. I explained the risks of leaving without further workup or treatment, which included reasonably foreseeable complications such as death, serious injury, permanent disability, and *. I also offered alternatives to departing AMA such as assigning the patient a different provider or an alternate workup pathway.	
The patient is refusing any further care, specifically *, and is leaving [[AMA (Against Medical Advice)]]. I am unable to convince the patient to stay. I have asked them to return as soon as possible to complete their evaluation, and also explained that they were welcome to return to the ER for further evaluation whenever they choose. I have asked the patient to follow up with their primary doctor as soon as possible. I have answered all their questions. Patient signed*did not sign AMA paperwork.	
April 18, 2018 Tagged AMA, capacity, MDM Leave a comment	
AMS – HEPATIC [[Encephalopathy (Altered (Level Of) Consciousness)]]	
This is a @[email protected] @[email protected] with a presentation consistent with acute [[Hepatic [[Encephalopathy (Altered (Level Of) Consciousness)]]]]. Exam notable for stigmata of [[Cirrhosis]] and [[PH (Portal [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]])]]. Likely precipitant: increased ammonia levels (GIB // excess protein // infection // electrolyte and/or acid base disturbance// [[Constipation]]) // dehydration (vomiting, diuretic use) // medication induced (opioids, [[Benzodiazepine Overdose]] or withdrawal // ETOH use.*** Low suspicion for acute GIB, including evidence of life threatening [[Hemorrhage]]. Low suspicion for acute infection including SBP (no fevers, [[Abdominal Pain]]). Presentation not consistent with other acute, emergent causes of [[AMS (Altered Mental Status)]] (including but not limited to renal failure, ICH) at this time.	
Plan: labs, LFTs, ammonia level, PT/INR, UA, CXR, CT brain*, diagnostic paracentesis*, serial reassessment	
[[Back Pain (Dolor)]] – LOW RISK	
This patient presents with [[Back Pain (Dolor)]] most consistent with ***. Differential diagnoses includes lumbago versus [[MSK (Musculoskeletal)]] spasm / strain versus [[Lumbar Radiculopathy]].	
No [[Back Pain (Dolor)]] [[Red Flag(s)]] on history or physical.	
Presentation not consistent with malignancy (lack of history of malignancy, lack of [[B (Systemic) Symptoms]]), fracture (no trauma, no [[Bony Tenderness]] to palpation), [[CES (Cauda Equina Syndrome)]] (no bowel or [[Urinary Incontinence]]/retention, no [[Saddle Anesthesia]], no distal weakness), AAA, viscus perforation , [[PE (Pulmonary [[Embolism]]/ous)]], [[Renal Colic]], [[Pyelonephritis]] (afebrile, no CVAT, no urinary symptoms).	
Given the clinical picture, no indication for imaging at this time.	
Plan: [[Pain Control]], supportive care, reassess	
CAPACITY ASSESSMENT	
YES:	
Capacity Assessment: In my medical opinion, this patient has capacity to make medical decisions. The patient has the ability to communicate their choice to me and others, understands the information relevant to this decision, appreciates the situation itself and the consequences inherent to their choice, and can logically explain their rationale for their decision.	
NO:	
In my medical opinion, this patient does NOT have capacity to make a medical decision regarding ***, because	
a. The patient is unable to communicate a choice.	
b. The patient is unable to understand the relevant information	
c. The patient is unable to appreciate a situation and its consequences	
d. The patient is unable to reason rationally.	
April 18, 2018 Tagged AMA, capacity, MDM Leave a comment	
CAPACITY ASSESSMENT	
MDM	
YES:	
Capacity Assessment: In my medical opinion, this patient has capacity to make medical decisions. The patient has the ability to communicate their choice to me and others, understands the information relevant to this decision, appreciates the situation itself and the consequences inherent to their choice, and can logically explain their rationale for their decision.	
NO:	
In my medical opinion, this patient does NOT have capacity to make a medical decision regarding ***, because	
a. The patient is unable to communicate a choice.	
b. The patient is unable to understand the relevant information	
c. The patient is unable to appreciate a situation and its consequences	
d. The patient is unable to reason rationally.	
April 18, 2018 Tagged AMA, capacity, MDM Leave a comment	
CDC Recommendations (2013)	
* Kuhar DT, Henderson DK, Struble KA, et al. Updated U.S. Public Health Service guidelines for the management of [[Occupational Exposure]]s to [[HIV (Human Immunodeficiency Virus)]] and recommendations for postexposure [[Prophylaxis]]. Infect Control Hosp Epidemiol 2013;34: 875-892. Available at: http://stacks.cdc.gov/view/cdc/20711	
Indications: Percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or potentially infectious body fluids, such as semen, vaginal secretions, and visibly [[Bloody Fluid]]s and reasonable suspicion that the source patient is HIV-infected.	
Source Testing:	
Although concerns have been expressed regarding HIV-negative sources being in the window period for seroconversion, no case of transmission involving an exposure source during the window period has been reported in the United States. Rapid HIV testing of source patients can facilitate making timely decisions regarding use of HIV PEP after [[Occupational Exposure]]s to sources of unknown HIV status.	
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Raltegravir 400 mg PO twice daily	
Duration of PEP: 4 weeks	
HIV Antibody Testing of Healthcare Worker	
Baseline	
6 weeks post-exposure	
12 weeks post-exposure	
6 months post-exposure	
Alternatively, if the clinician is certain that a fourth-generation antibody/antigen combination assay is being used, then HIV testing could be performed at baseline, 6 weeks, and concluded at 4 months post-exposure.	
PEP should be initiated as soon as possible, preferably within hours rather than days of exposure. Initiation of PEP should not be delayed while awaiting the results of a source patient’s HIV test, nor should it be delayed during consultation with experts to determine ideal PEP regimens.	
CHEST PAIN – ADMIT (HIGH RISK)	
This patient presents with chest pain, with a history suggestive of *. No evidence of [[Volume Overload]] or shock on exam. EKG without signs of active [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]. EKG without evidence of STEMI. Low suspicion for acute PE (Wells low risk *), [[PTX (Pneumothorax)]], [[Thoracic Aortic Dissection]], cardiac effusion / tamponade. Overall, ACS is being considered given higher risk features, *, history & physical. HEART score: *.	
Patient will require admission for inpatient risk stratification and possible [[Provocative Testing]].	
Plan: [[Cardiac Monitor]], EKG, troponins,CXR, ASA, [[Heparin]]*, [[Pain Control]], reassess, Cardiology consult*	
CHEST PAIN – ADMIT (HIGH RISK)	
MDM	
This patient presents with chest pain, with a history suggestive of *. No evidence of [[Volume Overload]] or shock on exam. EKG without signs of active [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]. EKG without evidence of STEMI. Low suspicion for acute PE (Wells low risk *), [[PTX (Pneumothorax)]], [[Thoracic Aortic Dissection]], cardiac effusion / tamponade. Overall, ACS is being considered given higher risk features, *, history & physical. HEART score: *.	
Patient will require admission for inpatient risk stratification and possible [[Provocative Testing]].	
Plan: [[Cardiac Monitor]], EKG, troponins,CXR, ASA, [[Heparin]]*, [[Pain Control]], reassess, Cardiology consult*	
January 3, 2018 Tagged acs, admit, cardiac, chest pain, MDM, nstemi Leave a comment	
[[CHF (Congestive v[[HF (Heart Failure)]])]] EXACERBATION – ADMIT	
Uncategorized	
This patient presents with signs and symptoms consistent with an acute exacerbation of chronic [[CHF (Congestive v[[HF (Heart Failure)]])]], likely due to ***. Differential diagnosis includes alternate cardiopulmonary causes such as [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]], PE, [[PTX (Pneumothorax)]], and pneumonia, as well as other causes of [[Dyspnea]] such as [[Asthma]]/RAD, COPD, [[APE; FPE ((Flash; Acute) PE (Pulmonary Edema))]], [[Dysrhythmia]] but these are less likely. Patient is generally [[Hemodynamic(ally) (Stability, Stable)]].	
Plan: labs, EKG, CXR, troponin, [[IV (Intravenous)]] [[Diuresis]], and electrolyte repletion. Will require admission for IV diuretics and medical optimization.	
October 26, 2018 Leave a comment	
[[CHF (Congestive v[[HF (Heart Failure)]])]] EXACERBATION – ADMIT	
Uncategorized	
This patient presents with signs and symptoms consistent with an acute exacerbation of chronic [[CHF (Congestive v[[HF (Heart Failure)]])]], likely due to ***. Differential diagnosis includes alternate cardiopulmonary causes such as [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]], PE, [[PTX (Pneumothorax)]], and pneumonia, as well as other causes of [[Dyspnea]] such as [[Asthma]]/RAD, COPD, [[APE; FPE ((Flash; Acute) PE (Pulmonary Edema))]], [[Dysrhythmia]] but these are less likely. Patient is generally [[Hemodynamic(ally) (Stability, Stable)]].	
Plan: labs, EKG, CXR, troponin, [[IV (Intravenous)]] [[Diuresis]], and electrolyte repletion. Will require admission for IV diuretics and medical optimization.	
[October 26, 2018](https://natedotphrase.com/2018/10/26/[[CHF (Congestive v[[HF (Heart Failure)]])]]-exacerbation-admit/) [Leave a comment](https://natedotphrase.com/2018/10/26/[[CHF (Congestive v[[HF (Heart Failure)]])]]-exacerbation-admit/#respond)	
[[CHF (Congestive v[[HF (Heart Failure)]])]] WITH SHOCK – ADMIT	
MDM	
This patient with a hx of *[[CHF (Congestive v[[HF (Heart Failure)]])]] presents with acute [[SOB (Shortness of Breath)]] and [[PE (Peripheral Edema)]], most consistent with [[ADHF (Acute DHF (Decompensated [[HF (Heart Failure)]]))]] and concerning for [[Cardiogenic Shock]]. Likely etiology is medication non-compliance // dietary indiscretion // HTN // infection // fluid overload // anemia //alcohol intoxication // thyroid disease.* I considered ACS as a possible etiology but think this less likely. EKG without overt evidence of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]]. Other acute, emergent etiologies of [[SOB (Shortness of Breath)]] are unlikely at this time.	
Given tenuous systolic function and [[Hypotensive]], plan includes starting ionotrope such as [[Dobutamine (DOBUTREX, INOTREX, GENERIC)]]	
#ERROR!	
(i.e. Dopamine, [[Levophed]]).	
Will give O2; would like to avoid utilizing [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] or intubation due to tenuous preload status.	
Will require admission for acute management of [[ADHF (Acute DHF (Decompensated [[HF (Heart Failure)]]))]].	
Plan: labs, troponin, [[BNP; BNF (Brain Natriuretic (Factor; Peptide))]], EKG, CXR, BUS, [[Vasopressor]], Cardiology consult***	
[January 3, 2018](https://natedotphrase.com/2018/01/03/mdm-[[CHF (Congestive v[[HF (Heart Failure)]])]]-with-shock-admit/) Tagged admit, cardiac, [[CHF (Congestive v[[HF (Heart Failure)]])]]](https://natedotphrase.com/tag/[[CHF (Congestive v[[HF (Heart Failure)]])]]/), MDM [Leave a comment](https://natedotphrase.com/2018/01/03/mdm-[[CHF (Congestive v[[HF (Heart Failure)]])]]-with-shock-admit/#respond)	
[[CHF (Congestive v[[HF (Heart Failure)]])]] – HYPERTENSIVE PULM EDEMA	
MDM	
This is a @[email protected] @[email protected] patient with history of * sided, *olic [[CHF (Congestive v[[HF (Heart Failure)]])]], presenting with likely [[ADHF (Acute DHF (Decompensated [[HF (Heart Failure)]]))]] and *[[PE (Pulmonary Edema)]]. The etiology of his decompensation is *unclear but is likely due to *. Alternative etiologies I considered include cardiac (ACS, valvular disease, [[Arrhythmia (Abnormal Rhythm)]], [[Myocarditis]]/[[Endocarditis]], dissection), respiratory (COPD, PE, or PNA), medication noncompliance or dietary indiscretion, alcohol or drug abuse, endocrine ([[Graves Disease (Thyrotoxicosis)]]), and anemia*. ***I considered ACS as a possible cause of the exacerbation but think this is unlikely given history and EKG without overt evidence of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]]. Other acute, emergent etiologies of [[SOB (Shortness of Breath)]] unlikely.	
I plan for afterload reduction with nitrates given [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] and possibly ACEi. Given respiratory status will also consider starting [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]]. Will start [[Diuresis]] after nitrate administration. The patient will require admission for acute management of [[ADHF (Acute DHF (Decompensated [[HF (Heart Failure)]]))]].	
Plan: labs, troponin, [[BNP; BNF (Brain Natriuretic (Factor; Peptide))]], EKG, CXR, BUS, nitrates/diuretics, admission	
__[January 3, 2018](https://natedotphrase.com/2018/01/03/[[CHF (Congestive v[[HF (Heart Failure)]])]]-hypertensive-pulm-edema-mdm/) Tagged admit, cardiac, [[CHF (Congestive v[[HF (Heart Failure)]])]]](https://natedotphrase.com/tag/[[CHF (Congestive v[[HF (Heart Failure)]])]]/),	
[[Hypertensive Emergency]]	
](https://natedotphrase.com/tag/hypertensive-emergency/), MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[CHF (Congestive v[[HF (Heart Failure)]])]]-hypertensive-pulm-edema-mdm/#respond)__	
[[Constipation]] – GI	
MDM	
This is a AGE YEAR presenting with symptoms consistent with [[Constipation]]. Differential diagnosis includes ***. Presentation not consistent with acute bowel obstruction caused by tumor, stricture, hernia, adhesion, volvulus or fecal impaction. Low suspicion for etiology related to new medications including opiates, [[Anti-Psychotic]], [[Anti-Cholinergic]]s, [[Antacid]], or antihistamines. Presentation not consistent with acute [[Anorectal]] disorders. Low suspicion for chronic causes of [[Constipation]] including [[Hypothyroid(ism)]] or [[Electrolyte Disorders]]. Presentation not consistent with other acute, emergent causes of [[Constipation]] at this time.	
Plan: supportive care, Rx *, XR abdomen*, electrolytes***	
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Constipation]]-gi-mdm/) Tagged [[Constipation]]](https://natedotphrase.com/tag/[[Constipation]]/), gi, low risk, MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[Constipation]]-gi-mdm/#respond)	
[[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]] – ADMIT	
MDM	
This patient presents with symptoms most consistent with an acute [[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]]. These [[Constellation]] of symptoms are similar to prior flares without overt deviations from normal exacerbations. The likely precipitant is acute respiratory infection // weather change or air quality // recent [[Beta (Adrenergic) Blocker]] or opiate use.*** Low suspicion for alternate etiologies such as [[PTX (Pneumothorax)]], acute PE. Presentation not consistent with other acute cardiopulmonary causes including ACS / [[CHF (Congestive v[[HF (Heart Failure)]])]] / cardiac effusion.	
Pseudomonas risk factors: recent hospitalization // frequent antibiotic treatment // severe COPD // previously isolated Pseudomonas.* Plan to maintain [[SaO2 (Oxygen Saturation)]] ~90-94% with [[Supplemental O2 (Oxygen)]]. Based on current presentation, including work of breathing, patient will need [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] ([[CPAP (Continuous Positive Airway Pressure)]]/BiPAP) // will not need [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] at this time. Plan for trial of [[Duoneb]]s, [[Steroid]]. Antibiotics *indicated given purulent sputum // increased sputum production // trial of [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] // No indication for antibiotic treatment at this time.*** Will evaluate for other acute cardiopulmonary processes with a CXR.	
Anticipate hospitalization given marked increase in symptoms // significant co-morbidities and age // new [[Arrhythmia (Abnormal Rhythm)]].***	
Plan: [[Supplemental O2 (Oxygen)]] (goal [[SaO2 (Oxygen Saturation)]] ~90-94%), [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]]*, [[Duoneb]]s, [[Steroid]], antibiotics*, CXR***, serial reassessment	
January 3, 2018 Tagged admit, copd, MDM, SOB Leave a comment	
COUGH, SIMPLE – LOW RISK	
MDM	
This patient presents with [[Acute Cough]], most consistent with *. Differential diagnosis includes *. Presentation not consistent with acute [[Bacterial Pneumonia]], influenza, [[Asthma]], transient airway hyperresponsiveness. Presentation not consistent with chronic causes of cough (including [[GERD (Gastroesophageal Reflux Disease)]], [[Asthma]], post[[Nasal Discharge]], medication side effect, [[CHF (Congestive v[[HF (Heart Failure)]])]], [[Carcinoma Of The Lung]] or mass).	
Plan: ***CXR, supportive care, reassess	
January 3, 2018 Tagged cough, low risk, MDM Leave a comment	
DKA – ADMIT	
This patient presents with [[Hyperglycemic]] and symptoms concerning for DKA. Differential diagnosis includes other metabolic causes of [[Hyperglycemic]] such as [[HHS (Hyperglycemic Hyperosmolar (Syndrome; State))]], worsened diabetes or medication noncompliance. Considered possible causes of DKA to include infection ([[Pancreatitis]], UTI, pneumonia), [[Infarction]] / [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]] ([[ACS (Acute Coronary Syndrome)]], cerebral vascular accident), medication non-compliance with [[INS (Insulin)]] therapy, [[Illicit (Substance; Drug) (Use)]] abuse, iatrogenic (including prescription medications and drug-drug interactions), idiopathic causes. Most likely etiology at this time is ***. Plan to treat the [[Hyperglycemic]] as below while simultaneously evaluating and treating potential underlying etiologies.	
Plan:	
POC [[BGM (Blood Glucose (Level) Monitoring)]] (Q1H), BMP (Q2H), [[Blood Gas]], UA, serum ketones, CBC, LFTs / lipase, infectious workup (lactate/blood cultures, [[Chest X-Ray]])***, IVF, IV [[INS (Insulin)]] therapy, serial reassessment, admission for treatment of [[Hyperglycemic]]	
[[Dyspnea]] – GENERAL	
MDM	
This patient presents with [[Dyspnea]], most likely secondary to *. Differential diagnosis includes *. Presentation not consistent with acute cardiac etiologies to include ACS (HEART score *), [[CHF (Congestive v[[HF (Heart Failure)]])]], [[Pericardial Effusion]] / tamponade . Presentation not consistent with acute respiratory etiologies to include acute PE (Wells low risk *), [[PTX (Pneumothorax)]] , [[Asthma]], [[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]], allergic etiologies, or infectious etiologies such as PNA. Presentation also not consistent with non-cardiopulmonary causes to include toxidromes, metabolic etiologies such as acidemia or electrolyte derangements, sepsis, neurologic causes (i.e. demyelinating diseases).	
Plan: [[Supplemental O2 (Oxygen)]], [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] ***, CXR, labs, troponin, close [[Hemodynamic Monitoring]], serial reassessment	
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Dyspnea]]-general/) Tagged [[Dyspnea]]](https://natedotphrase.com/tag/[[Dyspnea]]/), general, MDM, pulm, SOB [Leave a comment](https://natedotphrase.com/2018/01/03/[[Dyspnea]]-general/#respond)	
[[Epigastric (Abdominal) Pain]] – LOW RISK	
MDM	
Presentation consistent with acute [[Epigastric (Abdominal) Pain]]. Differential diagnosis includes ***. Abdominal exam without peritoneal signs. No evidence of [[Acute Abdomen]] at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng [[Acute Cholecystitis]]), [[Acute Pancreatitis]], PUD (including perforation), acute infectious processes (pneumonia, [[Hepatitis]], [[Pyelonephritis]]), atypical [[Appendicitis]], vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.	
Plan: labs, UA, GI cocktail, [[RUQ U/S (RUQ (Right Upper Quadrant) U/S ([[US(G) (Ultra(sound; -sonogram; sonography))]]))]] ***, serial reassessment	
-Courtesy Adam Evans	
January 3, 2018 Tagged [[Abdominal Pain]]](https://natedotphrase.com/tag/abdominal-pain/), adult, [[[Gastritis]]](https://natedotphrase.com/tag/[[Gastritis]]/), MDM Leave a comment	
[[Gallstone (Cholelithiasis)]] – LOW RISK	
This patient presents with [[Abdominal Pain]], most consistent with acute, uncomplicated [[Biliary Colic]].	
Bedside [[US(G) (Ultra(sound; -sonogram; sonography))]] demonstrating visible [[Gallstone (Cholelithiasis)]] without overt signs of [[Cholecystitis]] (thickened GB wall, [[Pericholecystic Fluid]], CBD [[Dilatation]]).	
Patient is afebrile and not jaundiced or altered, lowering my suspicion for [[Cholangitis]].	
Presentation not consistent with [[Acute Pancreatitis]] at this time.	
Low suspicion for bowel obstruction, viscus perforation, vascular catastrophe, or atypical [[Appendicitis]].	
Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.	
Plan for formal [[RUQ U/S (RUQ (Right Upper Quadrant) U/S ([[US(G) (Ultra(sound; -sonogram; sonography))]]))]] to evaluate [[Gallbladder]] pathology.***	
Plan: labs, LFTs, lipase, [[RUQ U/S (RUQ (Right Upper Quadrant) U/S ([[US(G) (Ultra(sound; -sonogram; sonography))]]))]]***, [[Pain Control]], supportive care, serial reassessment	
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Gallstone (Cholelithiasis)]]-mdm-lo-risk/) Tagged biliary, [[[Gallstone (Cholelithiasis)]]](https://natedotphrase.com/tag/[[Gallstone (Cholelithiasis)]]/), gi, low risk, MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[Gallstone (Cholelithiasis)]]-mdm-lo-risk/#respond)	
[[Gastroenteritis]] – LOW RISK	
MDM	
This patient presents with *** nausea, vomiting & [[Diarrhea]].	
Differential diagnoses includes possible acute [[Gastroenteritis]].	
Abdominal exam without peritoneal signs.	
Currently ***[[(Iso;Eu)volemia]] without evidence of dehydration.	
No evidence of surgical abdomen or other acute medical emergency including bowel obstruction, viscus perforation, vascular catastrophe, atypical [[Appendicitis]], [[Acute Cholecystitis]] at this time.	
Presentation not consistent with other acute, emergent causes of vomiting / [[Diarrhea]] at this time.	
No indication for abdominal imaging.	
Plan: supportive care, oral // IV rehydration ***, serial abdominal exam, reassess	
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Gastroenteritis]]-mdm-lo-risk/) Tagged [[[Gastroenteritis]]](https://natedotphrase.com/tag/[[Gastroenteritis]]/), gi, low risk, MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[Gastroenteritis]]-mdm-lo-risk/#respond)	
GENERAL [[Abdominal Pain]] – LO RISK	
MDM	
Differential diagnosis includes: ***.	
Abdominal exam without peritoneal signs. No evidence of [[Acute Abdomen]] at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng [[Acute Cholecystitis]]), [[Acute Pancreatitis]], PUD (including perforation), acute infectious processes (pneumonia, [[Hepatitis]], [[Pyelonephritis]]), [[Acute Appendicitis]], vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.	
Plan: labs, UA, CT AP***, [[Pain Control]], serial reassessment	
January 3, 2018 Tagged [[Abdominal Pain]]](https://natedotphrase.com/tag/abdominal-pain/), MDM Leave a comment	
HOMELESSNESS DOCUMENTATION – CA SB 1152	
DC, MDM	
I have provided a medical screening examination and evaluation.	
The patient is clinically stable for discharge. I have communicated post-discharge medical needs to the patient and the patient has been provided with or offered the following:	
Meal	
Weather appropriate clothing	
Prescription or adequate supply of medication from hospital outpatient pharmacy	
Referral to outpatient clinic for infectious disease screening	
Vaccines appropriate to the patient’s presenting medical condition	
Transportation has been arranged to patient’s post discharge destination.	
December 31, 2018 1 Comment	
HOMELESSNESS DOCUMENTATION – CA SB 1152	
DC, MDM	
I have provided a medical screening examination and evaluation.	
The patient is clinically stable for discharge. I have communicated post-discharge medical needs to the patient and the patient has been provided with or offered the following:	
Meal	
Weather appropriate clothing	
Prescription or adequate supply of medication from hospital outpatient pharmacy	
Referral to outpatient clinic for infectious disease screening	
Vaccines appropriate to the patient’s presenting medical condition	
Transportation has been arranged to patient’s post discharge destination.	
December 31, 2018 1 Comment	
[[Hyperglycemic]] – LO RISK	
This patient is a @[email protected] @[email protected], presenting with apparent acute [[Hyperglycemic]]. Differential diagnosis includes ***. Considered DKA versus [[HHS (Hyperglycemic Hyperosmolar (Syndrome; State))]], sepsis as possible etiologies of the patient’s current presentation. However, given the current history & physical, including current glucose level, the current presentation is consistent with acute, asymptomatic [[Hyperglycemic]]. Plan to treatment supportively. No indication for further workup at this time.	
Plan: supportive care, serial POC [[BGM (Blood Glucose (Level) Monitoring)]], labs***, serial reassessment	
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Hyperglycemic]]-lo-risk/) Tagged diabetes, dka, [[HHS (Hyperglycemic Hyperosmolar (Syndrome; State))]]](https://natedotphrase.com/tag/[[HHS (Hyperglycemic Hyperosmolar (Syndrome; State))]]/), [[Hyperglycemic]]](https://natedotphrase.com/tag/[[Hyperglycemic]]/), low risk, MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[Hyperglycemic]]-lo-risk/#respond)	
[[↓Glucose↓]] – GENERAL	
This patient presents with symptoms and labs consistent with acute [[↓Glucose↓]], most likely due to *. Differential diagnosis includes *. Considered other etiologies of acute [[↓Glucose↓]] to include drugs (anti-[[Hyperglycemic]]s, alcohol, [[Beta (Adrenergic) Blocker]], [[ACE-I (ACE (Angiotensin Converting Enzyme) Inhibitor)]], APAP) or drug related error (missed meal, incorrect dosing, intentional overdose), systemic illness (sepsis, [[ACS (Acute Coronary Syndrome)]], renal / [[(Liver; Hepatic) Failure]], [[Hypoadrenalism ((Acute; Severe) (Adrenal Insufficiency; ((Addisonian; Adrenal) Crisis))]]), malignancy, or post-op complications (i.e. Gastric bypass). Presentation not consistent with other acute, emergencies related to [[↓Glucose↓]].	
Plan: serial POC glucose, [[↓Glucose↓]] protocol treatment per routine, labs***, consider observation/admission, serial reassessment	
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[↓Glucose↓]]-general/) Tagged diabetes, [[↓Glucose↓]]](https://natedotphrase.com/tag/[[↓Glucose↓]]/), MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[↓Glucose↓]]-general/#respond)	
LINKS AND ATTRIBUTION	
Uncategorized	
Ty Dot Phrase: tydotphrase.wordpress.com	
An excellent, and more complete, list of dot phrases by a fellow co-resident. Also includes a large amount of educational pearls and high-risk diagnoses to consider.	
Brian T.’s Templates: brianemr.blogspot.com/	
A lengthy list of discharge instructions, albeit a little disorganized.	
—–	
All images obtained via FlatIcon with attributions below:	
Intestine: Icons made by Kirill Kazachek from www.flaticon.com is licensed by CC 3.0 BY	
Heart: Icons made by Freepik from www.flaticon.com is licensed by CC 3.0 BY	
Baby: Icons made by Smashicons from www.flaticon.com is licensed by CC 3.0 BY	
Uterus: Icons made by Roundicons from www.flaticon.com is licensed by CC 3.0 BY	
Muscle: Icons made by Vectors Market from www.flaticon.com is licensed by CC 3.0 BY	
Poison: Icons made by Freepik from www.flaticon.com is licensed by CC 3.0 BY	
Psych: Icons made by Those Icons from www.flaticon.com is licensed by CC 3.0 BY	
Kidneys: Icons made by Smashicons from www.flaticon.com is licensed by CC 3.0 BY	
House: Vectors Market from www.flaticon.com is licensed by CC 3.0 BY	
January 3, 2018 Leave a comment	
LOWER GIB – GENERAL	
MDM	
This patient presents with symptoms concerning for a lower [[Gastrointestinal Bleed]].	
Differential diagnoses include [[Diverticulitis]] (most common cause) versus [[Hemorrhoid (Pile)]].	
Less likely etiologies include angiodysplasia, cancer, IBD.	
Presentation not consistent with [[Mesenteric [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] or [[Ischemic Colitis]], brisk or life threatening upper GIB as patient has no evidence of [[Hemorrhagic Shock]].	
Plan to check labs to evaluate the extent of bleeding, including H/H.	
Will consent patient for blood and transfuse to goal Hb of >7 if necessary.	
No indication for abdominal imaging at this time.***	
Plan: labs, LFTs, close [[Hemodynamic Monitoring]], serial reassessment, CT AP***	
PANIC ATTACK – LOW RISK	
MDM	
This patient presents with symptoms consistent with acute anxiety reaction / panic attack. Low suspicion for acute cardiopulmonary process including ACS, PE, or [[Thoracic Aortic Dissection]]. Denies any ingestions or any other medical complaints. No evidence of [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Presentation not consistent with overt toxidrome, ingestion given history & physical. Presentation not consistent with organic or medical emergency at this time. No acute indication for psychiatric consultation (without SI/HI, AH/VH). Cautious return precautions discussed with full understanding.	
Plan: Rx ***, Psych follow up PRN	
January 3, 2018 Tagged low risk, MDM, panic attack, psych Leave a comment	
[[Paresthesias]] – LO RISK	
MDM	
This * patient presents with [[Paresthesias]], most likely due to *. Differential diagnoses includes ***. Presentation not consistent with emergent neurologic etiologies to include brain / spinal cord nerve root or nerve problem given history & physical. Presentation not consistent with immune phenomenon to include GBS or vasculitis. Presentation not consistent with [[Toxins]] to include [[Botulism]], diptheria, tick-borne illnesses, [[Heavy Metal]] poisoning. Presentation not consistent with acute drug toxicity or metabolic issues.	
Plan: labs*, CT brain*, supportive care, reassessment	
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Paresthesias]]-lo-risk/) Tagged low risk, MDM, neuro, [[Numbness]]](https://natedotphrase.com/tag/[[Numbness]]/), [[[Paresthesias]]](https://natedotphrase.com/tag/[[Paresthesias]]/) [Leave a comment](https://natedotphrase.com/2018/01/03/[[Paresthesias]]-lo-risk/#respond)	
PEDS COUGH – URI	
Peds	
* year old * presenting with cough. Patient is afebrile. Presentation consistent with uncomplicated viral URI given classic history and [[PE (Physical Exam(ination))]], positive sick contacts, and well-appearing child***. No warning signs of systemic infection (fevers, tachypnea) to suggest pneumonia, and lung sounds clear on exam. No [[Photophobia]] or neck stiffness/pain to suggest meningitis. No rash. No clinical evidence of dehydration and child is taking excellent PO and making multiple wet diapers per day. Patient has attentive parents and good follow up.	
Plan: Discharge to home with strict return precautions, encourage PO hydration, return to ***clinic/ER in 48 hours if no improvement	
January 2, 2018 Tagged cough, Peds, uri Leave a commen	
PEDS – APPY RULE OUT	
Peds	
* is a *y/o child who presents with [[Abdominal Pain]], vomiting, anorexia, concerning for [[Appendicitis]].	
Differential includes [[Gastritis]] or early [[Gastroenteritis]], although history suggests appy is at least equally likely.	
[[Intussusception]], [[Meckel]]’s also a possibility but would be atypical given patient age.	
Similarly volvulus or malrotation unlikely given otherwise well-appearing patient without peritonitic/rigid abdomen.	
Unlikely to represent UTI given no [[Dysuria]], no [[Suprapubic Pain]].	
Would be an atypical presentation of pneumonia and patient is normoxemic without [[Dyspnea]] or cough.	
Low index of suspicion for *gynececological etiologies such as torsion, TOA, or ectopic given * OR *[[Testicular Torsion]], orchitis/[[Epididymitis]] given *.	
Plan: ***	
January 2, 2018 Tagged appenciditis, Peds Leave a comment	
PEDS – [[Gastritis]] – NONTOXIC	
Peds	
* is a * y/o otherwise healthy *** with mid[[Epigastric (Abdominal) Pain]] worsened with eating, most consistent with [[Gastritis]]. Reassuring that his pain was relieved with OTC [[Antacid]]. Differential includes [[GERD (Gastroesophageal Reflux Disease)]], early [[Gastroenteritis]], PUD. Low suspicion for referred cardiac etiologies given age and lack of fmhx early heart disease. Denying chest pain. No infectious symptoms (tachypnea, fever/chills, etc) to suggest bacterial infection such as PNA or biliary tree infection. No urinary symptoms to suggest UTI, no RLQ or migratory pain or fever to indicate a concern for appy. No blood/mucus in stool to suggest invasive bacterial species. Otherwise well-appearing child, tolerating adequate PO and not dehydrated.	
Plan: discharge to home with return precautions, encourage PO hydration,	
***recommend OTC meds	
such as [[ZanTAC (Ranitidine)]], tums	
[January 2, 2018](https://natedotphrase.com/2018/01/02/peds-[[Gastritis]]-nontoxic/) Tagged [[[Gastritis]]](https://natedotphrase.com/tag/[[Gastritis]]/), Peds [Leave a comment](https://natedotphrase.com/2018/01/02/peds-[[Gastritis]]-nontoxic/#respond)	
PEDS – GASTRO/AGE – NONTOXIC	
Peds	
This is a *** pt presenting with [[Abdominal Pain]], +fever, +[[Myalgia]], +[[Diarrhea]], and nausea most consistent with viral [[Gastroenteritis]].	
***sick contacts with similar symptoms.	
Differential includes invasive/toxic [[Diarrhea]], sepsis, influenza, along with the far less likely surgical etiologies such as volvulus, [[Appendicitis]], malro, and SBO.	
No change in diet or abnormal exposures.	
No known stagnant water exposure, recent camping/hiking.	
No dietary history or bloody BM’s suggestive of B. Cereus, [[SA (S(taphylococcus) Aureus)]], or other invasive bacterial enteric pathogens.	
Pt with good capillary refill (<2 sec), MMM, and is nonseptic in appearance.	
Clinically is not dehydrated.	
Unlikely to represent unusual manifestation of UTI, [[GERD (Gastroesophageal Reflux Disease)]], partial or complete anatomical obstruction, or other [[Acute Abdomen]].	
Pt tolerating PO rehydration and is very well-appearing.	
Plan: Presumed self-limited etiology; plan to DC home with return precautions and oral rehydration education.	
January 2, 2018 Tagged AGE, gastro, [[[Gastroenteritis]]](https://natedotphrase.com/tag/[[Gastroenteritis]]/), Peds Leave a comment	
PSYCH – BOARD & TRANSFER	
MDM	
This patient presents with symptoms consistent with an underlying psychiatric disorder, most likely *. Differential diagnosis includes *. Presentation not consistent with acute organic causes to include delirium, dementia or [[Drug Induced]] disorders (acute ingestions or withdrawal; no evidence of toxidrome). Given the H&P, I suspect this patient is *suicidal/homicidal/gravely disabled and will require psychiatric care. Will consult psychiatry to evaluate the patient for potential hold for *. Will also obtain labs for medical clearance.	
Plan: labs*, EKG*, ASA/APAP levels*, ETOH level*, UDS*, ICON*, Psych consult, medical detainment, reassess	
January 3, 2018 Tagged general, gravely disabled, homicidal, psych, suicidal Leave a comment	
[[Rectal Bleed]] – LOW RISK	
MDM	
This patient has a presentation consistent with [[Rectal Bleeding]], most likely due to *. Differential diagnosis includes *. Low suspicion for [[Hemorrhoid (Pile)]] (external or internal, including [[Thrombosed Hemorrhoid]]s), [[Rectal Ulcer]] (HIV, syphilis, STI) or rectal [[Foreign Body]]. Presentation not consistent with other acute, emergent causes of upper or lower [[Gastrointestinal Bleeding]]. No evidence of [[Hemorrhagic Shock]].	
Plan to check labs to evaluate the extent of bleeding, including H/H. No indication for abdominal imaging at this time.***	
Plan: CBC, serial reassessment, PMD / GI referral	
RLQ [[Abdominal Pain]]	
MDM, Peds	
This is a * with [[Right Lower Quadrant (RLQ) Pain]], most concerning for *. Differential diagnoses: [[Appendicitis]], ***. Abdominal exam without peritoneal signs. No evidence of [[Acute Abdomen]] at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng [[Acute Cholecystitis]]), acute infectious processes (pneumonia, [[Hepatitis]], [[Pyelonephritis]]), vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.	
Plan: labs, UA, CT AP ***, [[Pain Control]], fluids, serial reassessment	
January 3, 2018 Tagged [[Abdominal Pain]]](https://natedotphrase.com/tag/abdominal-pain/), MDM, rlq Leave a comment	
RUQ [[Abdominal Pain]]	
MDM	
This is a @[email protected] @[email protected] with RUQ [[Abdominal Pain]], consistent with ***.	
Differential diagnosis includes ***. Abdominal exam without peritoneal signs. No evidence of [[Acute Abdomen]] at this time. Well appearing. Moderate suspicion for acute hepatobiliary disease (includng [[Acute Cholecystitis]]). Less likely to represent [[Acute Pancreatitis]], PUD (including perforation), acute infectious processes (pneumonia, [[Hepatitis]], [[Pyelonephritis]]), atypical [[Appendicitis]], vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.	
Plan: labs, UA, [[Pain Control]], [[RUQ U/S (RUQ (Right Upper Quadrant) U/S ([[US(G) (Ultra(sound; -sonogram; sonography))]]))]]***, serial reassessment	
January 3, 2018 Tagged [[Abdominal Pain]]](https://natedotphrase.com/tag/abdominal-pain/), adult, [[Cholecystitis]]](https://natedotphrase.com/tag/[[Cholecystitis]]/), MDM, ruq Leave a comment	
SEIZURE – GENERAL	
MDM	
This patient presents with symptoms consistent with acute seizure, most likely due to ***. I considered, but think less likely, secondary etiologies of epileptic [[Seizure]] to include drug / toxin etiologies (ETOH, stimulants, medication side effects), metabolic disturbances (glucose, Na), acute [[CNS (Central Nervous System) Infection]] (meningitis, [[Cerebritis; Encephalitis]], abscess), ICH / tumor / CVA. Presentation not consistent with non-epileptic type seizure to include syncope, neurologic etiologies ([[Vertebrobasilar Artery Insufficiency (VBI)]], movement disorder, [[Migraine (Headache)]]), impact seizure related to head trauma.	
Plan: BZDs, labs*, CT brain*, seizure precautions, Neurology consult***, reassess	
Pearls	
Consider nonconvulsive status: persistent change in behavior that lasts 30 minutes after a seizure. Look for [[Positive Symptoms]] (twitching, eye deviation, jerking) and negative (aphasia, [[Catatonia (Syndrome)]], mutism). Many patients will just not respond. Think about this in head trauma patients with a decreased GCS and a negative initial CT. Also consider this in a “septic” altered patient with a borderline positive UA that isn’t that convincing.	
January 3, 2018 Tagged general, MDM, neuro, seizure Leave a comment	
STEVEN	
DC, MDM, Peds, [[PE (Physical Exam(ination))]]](https://natedotphrase.com/tag/physical-exam/)	
All updates courtesy Steve Lai and Brian Truong	
MEDICAL [[Decision Making]]	
MDMAlcohol	
Patient presents with acute alcohol intoxication without evidence of co-ingestion or trauma per history and exam. Will observe patient in ED with frequent monitoring and reassessment. Plan to PO trial, reassess mental status, and assess gait when more stable. No evidence of withdrawal currently.	
MDMAMA	
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.	
MDMANKLE	
Neurovascularly intact. Query likely ankle sprain. Discussed conservative measures including rest, elevation, alternating application of ice, [[Pain Control]] and early ambulation as tolerated. No gross ankle instability. No evidence of maison-neue. Discussed follow up with PMD and given resources for ortho/sports medicine follow up as needed. Discussed strict return precautions for neurovascular insufficiency or need for repeat imaging/evaluation if pain not vastly improved in 5-7 days for possible occult fracture.	
Patient with likely [[AOM (Acute Otitis Media)]] given history and exam. No overt e/o [[Mastoiditis]] or [[Malignant (Necrotizing) Otitis Externa]]. Nontoxic appearing with low suspicion for intracranial extension. Tolerating PO, low suspicion for concurrent serious bacterial infection. Will discharge home with [[Amoxicillin (MOXATAG)]] (high dose), auralgan, tylenol, follow up peds_. Cautious return precautions discussed w/ full understanding.	
MDM[[Asthma]]	
Patient presenting with [[SOB (Shortness of Breath)]]. Given exam and history, suspect likely acute [[Asthma Exacerbation]] without_ [[Status [[Asthma]]ticus]]. These [[Constellation]] of symptoms are similar to prior flares without overt deviations from normal exacerbations. Given clinical findings and history, low suspicion for pneumonia, [[PTX (Pneumothorax)]], or acute valvular failure. Patient with minimal risk factors for [[PE (Pulmonary [[Embolism]]/ous)]] and atypical ACS. As such, will trial bronchodilators, [[Steroid]], monitor respiratory status closely, reassess.	
MDMBackPain	
Patient presents with several days_ of [[Lower [[Back Pain (Dolor)]]]], atraumatic, afebrile. Given history and exam, suspect likely [[MSK (Musculoskeletal)]] etiology_. Nontoxic appearing and no overt risk factors for [[EDH (Epidural Hematoma)]] or abscess. No overt e/o [[CES (Cauda Equina Syndrome)]] or acute critical cord compression with nonfocal neuro exam. Neurovascularly intact distally. No e/o prostatitis or [[Fournier Gangrene]]. No peritoneal signs or [[Abdominal Pain]] on exam with low suspicion for AAA.	
Patient presents with [[Abdominal Pain]] and [[US(G) (Ultra(sound; -sonogram; sonography))]] demonstrates visible [[Gallstone (Cholelithiasis)]]. Given exam and history, suspect likely uncomplicated_ [[Biliary Colic]]. Patient is afebrile without overt thickening of the [[Gallbladder]] wall, CBD dilation or [[Pericholecystic Fluid]] suggests the absence of [[Acute Cholecystitis]] or acute biliary obstruction. Patient is tolerating PO_ and suspicion for acute pancreatic involvement is low. After serial abdominal exams, history and observation, low suspicion at this time for other acute intraabdominal processes, including [[AA (Aortic Aneurysm)]], atypical [[Appendicitis]], [[Diverticulitis]], or bowel obstruction. Given resolution of pain and no peritoneal signs on serial exams, will discharge patient home with general surgery follow up and strict return precautions.	
Wound inspected under direct bright light with good visualization.	
Area with linear laceration across soft tissue through adipose without exposure of muscle belly or tendon_.	
No overt [[Foreign Body]].	
Area hemostatic.	
Neurovascular exam congruent with above.	
Area extensively irrigated with sterile [[0.9% NS; NaCl (Normal Saline; [[Na+ (Sodium; 135-145 mEq/L)]] Cl- (Chloride (95-105))]] under pressure.	
Laceration repaired in simple fashion as below (please see procedure note for further details)_.	
Patient tolerated procedure well and neurovascular exam intact and unchanged post repair with intact distal pulses and cap refill_.	
Cautious return precautions discussed w/ full understanding.	
[[Wound Care]] discussed.	
Prompt follow up with primary care physician discussed and return for suture removal.	
history of [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] presents for [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] with SBP _ sent in by PMD with concern for possible [[Pre-Eclampsia]]. Of note, patient without severe range BP in ED. Patient without neuro or ocular concerns at this time. No RUQ and no frank proteinuria. No seizure activity and without cardiothoracic symptoms.. Benign abdominal exam and non-focal neuro exam. Labs largely reassuring_. Therefore, given history and exam, low suspicion at this time for [[Fulminant]] [[Pre-Eclampsia]] requiring admission. No overt evidence of HELLP, acute [[Cholestasis]] of pregnancy, or eclampsia at this time. Discussed case with OB and after evaluation, will _. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician/OB arranged and discussed_.	
Patient presenting with [[Constellation]] of symptoms concerning for vitreous [[Hemorrhage]] vs [[Retinal Detachment]]. Not contact lens wearer_. No prior ocular history_. Patient is headache free and visual acuity intact with low suspicion for [[GCA; TA ((Giant Cell; Temporal) Arteritis)]] or [[CRAO (Central RAO (Retinal Artery Occlusion))]]/CRVO. No vision changes or [[Conjunctival Injection]] with low suspicion for acute [[Angle Closure Glaucoma]]. No trauma to the eye and no sensation of [[Foreign Body]] with low suspicion for [[Cornea(l) Ulcer(ation)(s)]] or globe injury. No evidence of overt [[Hyphema]] or [[Hypopyon(s)]] on exam. No ocular pain or consensual [[Photophobia]] with low suspicion for scleritis or iritis. Plan to discuss case with ophthalmology for dilated exam and further assessment.	
Patient is currently at baseline mental status and activity level per family. Patient does not have evidence of palpable [[Skull Fracture]]s or step offs. Patient does not have an occipital, parietal or temporal hematoma. Denies LOC > 5 seconds. No signs of basilar skull injury including [[Raccoon eyes]], [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], CSF rhinorrhea or hemotympanum. No nasal hematoma. Denies vomiting or headache. Denies severe mechanism of injury.	
MDMPEP	
After extensive discussion with patient regarding PEP versus observation/follow up and risks and benefits of both, mutual [[Decision Making]] to provide first dose of PEP and follow up promptly with outpatient testing and further treatment as needed at this time per most recent CDC HIV PEP guidelines for unknown relatively high risk exposures_. Discussed that single dose of PEP is not a substitute for follow up and further care/evaluation. Discussed need for concurrent testing of other STI including, but not limited to, G/C and RPR. Discussed safe sex practices_. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
Denies any ingestions and denies any other medical complaints. Does not endorse any [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Engages with conversation. Mood and affect are congruent. Thoughts are linear and organized, and has no AH or HI. Plan admit to psychiatry for further management of symptoms. Will consult psychiatry to evaluate Patient for potential hold for danger to self. Clinically no overt toxidrome, well appearing, low suspicion for ingestion given history and exam.	
MDMRabies	
_ with bat exposure who presents for [[IgA (Ig (Immunoglobulin) A)]]dministration. Patient without obvious wound but given duration of exposure, high risk nature and possible [[Incubation Period]] (of up to 1-3 months), mutual [[Decision Making]] with patient re: R/B/A to give dose of RiG. Per most recent CDC/ACIP guidelines re: PEP for human rabies, patient with 1st of 4-dose rabies vaccination regimen prior to arrival (0, 3, 7, 14; HDCV or PCECV). Discussed need for subsequent doses. Patient without altered immune competence. No obvious inoculation wound, as such, will infiltrate weight based RIG IM_. Patient currently largely asymptomatic with non-focal exam with no symptoms of cerebral dysfunction, anxiety, confusion, agitation, delirium, abnormal behavior, [[Hallucinations]], and [[Insomnia (Nighttime Wakefulness)]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
MDMRenalColic	
Patient presents with flank pain consistent with previous [[Nephrolithiasis ((Kidney; Renal) Stone(s))]] pain. Patient otherwise well-appearing with low suspicion for sepsis, dissection or infected obstructed [[Renal Colic]]. US w/ mild [[Hydronephrosis; Ureterectasis (Hydro;Ureter(o));(nephrosis;ectasis))]] on affected side_. Low suspicion for atypical [[Appendicitis]], torsion, acute chole, or intraabdominal infection. Discussed conservative management, strict return precautions and follow up with urology. Will discharge with [[FLOMAX (Tamsulosin)]]_, [[NSAID (Non Steroidal Anti Inflammatory Drug)]], opiates for breakthrough, strainer, and antiemetics. Patient tolerating PO and [[Pain Control]]led prior to discharge. Strict return precautions for infected stone or PO intolerance discussed. Low suspicion for AKI, obstructive nephropathy given exam and history.	
MDMSepticArthritis	
Given exam and history, low suspicion for [[Septic Arthritis]] at this time given location of pain (not over knee joint but superior to area), subacute nature, and relative comfort to range of motion and axial loading. Nontoxic appearing and no overt systemic symptoms. Atraumatic with low suspicion for fracture or dislocation. No overt e/o [[NF (Necrotizing Fasciitis)]]. Given tenderness and area of erythema, will treat for cellulitis. Neurovascularly intact per routine as above with no overt e/o [[Compartment Syndrome]].	
After extensive discussion with patient and wife regarding observation and treatment of possible cellulitis versus [[Arthrocentesis]] and risks (overlying cellulitis, lower [[Pre-Test]] probability of [[Septic Arthritis]], risk of inoculation of joint) and benefits of both, mutual [[Decision Making]] to trial antibiotics and not pursue further [[Arthrocentesis]] at this time. Patient tolerating discomfort, continue to be at baseline and well appearing. As above, does not have signs of systemic symptoms or neuro[[Vascular Compromise]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with increase in pain, inability to range or bear weight, or fevers.	
MDMSyncopeFall	
Patient presents after ground level fall, currently in c-spine precautions with likely LOC_. Unwitnessed fall, with unclear etiology, possible mechanical but cannot r/o syncope at this time. Patient without any [[Prodrome]] symptoms with low suspicion at this time for ACS, dissection or malignant [[Arrhythmia (Abnormal Rhythm)]]. Will check labs for electrolyte protuberances, will obtain CT brain and C-spine to evaluate for ICH as patient is [[Anti-Coagulation]]d_. Given history, low suspicion for ACS, but will obtain troponin and EKG for cardiac evaluation and reassess_. Currently at baseline mental status. No [[Respiratory Distress]] or hypoxia with low suspicion for massive PE at this time. Serial neurologic exams and monitor in interim.	
MDMNeckSwelling	
Patient otherwise healthy_, fully vaccinated_ with anterior neck swelling likely secondary to significant lymphadenopathy of limited duration with suspicion for likely viral etiology. BUS with visualization of LAD without frank abscess. Mild [[Tetanus (Tetany; Trismus; Lockjaw)]] on exam but no overt e/o PTA or RPA. No overt e/o deep space infection; nontoxic appearing and tolerating PO. Non-focal neuro exam with low suspicion for [[Lemierre Syndrome]]. Vaccinated with low suspicion for mumps. Low suspicion for malignancy or goiter formation at this time given duration but discussed prompt follow up to reassess. Trial antibiotics_ and [[Steroid]]_ with cautious return precautions discussed w/ full understanding. Airway fully patent.	
Patient presents with epigastric_ [[Abdominal Pain]] most likely secondary to [[Dyspepsia (Indigestion)]] or non-acute abdominal etiology.	
No peritoneal signs on abdominal exam.	
Patient’s symptoms near resolved with GI cocktail.	
Patient remains PO tolerant.	
Serial abdominal exam without increase in [[Abdominal Pain]].	
Given exam and history, low suspicion for acute abdominal process, such as [[Acute Cholecystitis]], [[Pancreatitis]], perforated viscus, atypical [[Appendicitis]] or torsion.	
Extensive conversation about return precautions and need for follow-up.	
Patient with rash likely allergic or [[Contact Dermatitis]] in nature given history, temporal nature and appearance. No mucous membrane involvement with low suspicion for SJS/TEN. No [[Wheez(-e -es; -ing)]] or difficulty breathing with low suspicion for systemic involvement. Unclear trigger but discussed close monitoring for progression. Will prescribe single dose of steroid given extent of rash and [[Hydrocortisone (Synthetic Cortisol; CORTAID)]] cream_. Cautious return precautions discussed w/ full understanding. No overt e/o superinfection. Prompt follow up with primary care physician discussed.	
Patient with _ apical abscess over _lower right posterior molar presenting for [[Pain Control]]. Patient well appearing, no [[Tetanus (Tetany; Trismus; Lockjaw)]] or airway involvement. No systemic symptoms and no overt e/o deep space extension. Mutual [[Decision Making]] to perform inferior alveolar [[Nerve Block]] for temporary relief and continued control with short course of [[NSAID (Non Steroidal Anti Inflammatory Drug)]] and opiates as outpatient_. Apical abscess I+D extended and small amount of pus expressed with [[Decompression]] of lesion. Low cost dental resources given. Cautious return precautions discussed w/ full understanding.	
MDMPEDS[[Appendicitis]]NoScan	
Patient with [[Abdominal Pain]] and vomiting, now resolved_. No peritoneal signs with low suspicion for acute intraabdominal process including torsion, SBO, [[Intussusception]] or atypical [[Appendicitis]]. Serial abdominal exams throughout course without increase in pain or migration of pain. Tolerating PO in ED. US appendix inconclusive_. After extensive discussion with family regarding observation versus CT versus return for recheck in 8-12 hours if not resolved and risks and benefits of options, mutual [[Decision Making]] to return for recheck given relative improvement and well appearing child with alternative diagnoses (_) for fever and [[Malaise]] and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of peritoneal involvement. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting, increase in [[Abdominal Pain]], or altered behavior. Will discuss prompt follow up with PMD and strict return precautions discussed.	
MDMBartholins	
Patient with _ [[Bartholin Gland Cyst]] with concurrent abscess formation. No overt evidence of [[Fournier Gangrene]] or deep space involvement. No systemic symptoms. Small medial incision made with copious drainage of pus. Insertion of [[Word Catheter]] to maintain tract and follow up with OB/GYN discussed. [[Wound Care]] and return precautions discussed.	
Patient with possible latrodectus envenomation to dominant hand_ several hours prior. Now with [[Constellation]] of symptoms, potentially consistent with mild envenomation including diffuse pain in extremity. Hand with possible area of early cellulitis but no frank abscess formation. Will treat with doxy given allergy profile after conversation with pharmacist. Area of inoculation without local [[Sweating]]. No overt evidence of necrosis or abscess. No cardiothoracic symptoms, no peritoneal signs. At this time, will trial [[Pain Control]] and muscle relaxants. Will continue to monitor and will hold antivenom at this time. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] up to date.	
with no previous medical history presents brought in by parents for superficial scattered burns primarily to torso_ with minimal BSA involved. Burns superficial, consistent with history and given interaction observed between parents, low suspicion at this time for NAT. Parents and patient appropriate. Patient undressed fully without any suspicious lesions. Discussed [[Wound Care]], [[Pain Control]] and follow up with PMD. Return precautions for superinfection. Patient at baseline currently without significant burns over scalp, face, groin or distal extremities. Cautious return precautions discussed w/ full understanding.	
with atypical [[Chest Discomfort]] and now resolved palpitations in the setting of Adderall_ use. No overt risk factors for early cardiac disease; no family history of early cardiac death. Patient well appearing, nontoxic. Low Wells score with low s/f PE; no overt hypoxia. Given history and exam, low suspicion for ACS, dissection, or [[PTX (Pneumothorax)]]. Discussed cessation of Adderall_ and follow up with PMD for further evaluation as needed. Cautious return precautions discussed w/ full understanding.	
with history of tobacco abuse, otherwise healthy, p/w atypical chest pain, subacute worsening of [[Chronic Pain]]. No overt risk factors for ACS and serial EKGs and troponins without overt e/o [[NSTEMI (Non ST (Segment) Elevation [[MI (Myocardial Infarction)]])]]. Pain reproducible on exam with likely [[MSK (Musculoskeletal)]] component. Low Wells score with low risk for PE and no significant hypoxia_. Given chronicity, low s/f dissection. [[Pain Control]]led, well appearing. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
p/w atypical chest pain, subacute onset of atypical chest pain. No overt risk factors for ACS aside from HLD_ and EKG w/o overt e/o [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]]. Pain reproducible on exam with likely [[MSK (Musculoskeletal)]] component. Low Wells score and PERC negative with low risk for PE and no significant hypoxia. Given duration, low s/f dissection. [[Pain Control]]led, well appearing. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
Patient presents with chest pain without signs of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] on ECG. Patient given aspirin and is currently chest pain free. Low Wells score with low risk for PE and no significant hypoxia_. Given exam and history, low suspicion for dissection. No ectopy noted on monitor and patient well appearing. Had conversation with pt at length regarding risks vs benefits of admission to obs for chest pain. Mutual [[Decision Making]] for patient to be admitted to obs, and agrees to workup. Low suspicion for overt ACS but given age and persistence of symptoms, plan to admit to obs for [[Serial Troponin]], serial EKGs, and risk stratification as inpatient.	
with worsening [[SOB (Shortness of Breath)]] over the past few weeks with [[Constellation]] of symptoms concerning for possible [[CHF (Congestive v[[HF (Heart Failure)]])]] exacerbation. Patient not overtly hypoxic with minimal [[Respiratory Distress]]. No overt evidence of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] on EKG. Will trial [[Nitroglycerin(e)]] for afterload reduction, [[Diuresis]] with strict I/O presuming no evidence of AKI or cardiorenal syndrome_. Trend troponin although low suspicion for [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] given history and exam_. Low suspicion for acute PE given exam and history. Given decline in functional status, consider admission for [[Diuresis]] and further cardiac evaluation_.	
MDM[[Clavicular]]Fracture	
Patient with L_ minimally displaced [[Clavicular Fracture]] after falling onto L side. Distally neurovascularly intact in extremities. No overt evidence of significant head trauma. Mentating well with non-focal neurologic exam. Placed in sling and [[Adhesive Capsulitis (Frozen Shoulder Syndrome)]] precautions discussed. Follow up with pediatric orthopedics. Return precautions.	
presenting s/p minor head trauma with headache, lightheadedness, and nausea_. Given mechanism and nonfocal neurologic exam, low suspicion at this time for ICH or significant C-spine injury. Concussion care and precautions discussed. After extensive discussion with patient and family_ regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Patient with nonfocal neurologic exam and with low suspicion for overt ICH. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.	
presenting with 1 day of left [[Eye Pain]]_ after irritation yesterday. Patient is a contact lens-wearer. Visual acuity otherwise preserved. Given exam and history, no overt evidence of scleritis, purulent conversion, or [[Cornea(l) Ulcer(ation)(s)]]. Patient does however have small [[Corneal Abrasion]], which will be treated with antibiotic eyedrops_. Patient to avoid wearing contacts in interim and prompt follow up with ophthalmology discussed.	
Patient without overt maloccusion and given mechanism and history, low suspicion at this time for significant mandibular or maxillary fracture and will defer imaging at this time. Prompt follow up with plastics arranged and discussed. In regards to fractured dentition, likely Ellis II_, patient with access to [[Dentist]] in 24 hours and after R/B/A discussed, patient deferred antibiotics and cementing of tooth which is reasonable given degree of fracture and prompt follow up. Strict return precautions discussed.	
with isolated episode of [[Binocular Diplopia]] now resolved with nonfocal neuro exam with low suspicion for TIA.	
Patient with minimal neurovascular/CVA risk factors and with prompt follow up with neurology already arranged.	
Low suspicion given exam and history for CNS or facial infection including meningitis or [[CST (Cavernous Sinus Thrombosis)]] (no facial tenderness, ptosis and no limitation of [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]], IV, V, VI) , aneursym (no e/o [[CN3 (Cranial Nerve III) Palsy]], headache, no personal or family history).	
No e/o [[Horner Syndrome]] or inflammatory process (i.e. GBS/MF, myasthenia, or [[GCA; TA ((Giant Cell; Temporal) Arteritis)]]).	
Exam and history with no overt e/o monocular diplopia with low suspicion for acute media or refractive pathology, [[Optic Neuritis]], or uveitis.	
with elbow pain after fall. X-ray does not reveal any overt fractures. Discussed discharge instructions with patient and return precautions. Given sling for comfort and [[Adhesive Capsulitis (Frozen Shoulder Syndrome)]] precautions discussed. No overt e/o [[Compartment Syndrome]] or [[Supracondylar Fracture]]. Distally NVI per routine. Patient is well-appearing, in no apparent distress, and vital signs stable for discharge home. Return precautions for occult fracture and return for repeat imaging if needed discussed.	
Patient with ground level fall _ without frank head trauma and non-focal neurologic exam. Patient with multiple abrasions but no lacerations requiring repair_. Affected areas inspected, irrigated and dressings applied. [[Wound Care]] discussed. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] up to date. Patient initially with mild headache_, single episode of emesis_ without frank abdominal injury and [[Shoulder Pain]], now resolved_. Given nonfocal exam and currently well appearing, query possible mild concussive symptoms_. As above, given mechanism and nonfocal neurologic exam, low suspicion at this time for ICH or significant C-spine injury. Concussion care and precautions discussed. After extensive discussion with patient and companion regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Friend agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.	
otherwise healthy, full term, brought in by parents for 1 day_ of increased fussiness. Afebrile, full term, currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing [[(Iso;Eu)volemia]] with appropriate linear [[Weight Gain]] since birth. No meningismus, otherwise at baseline activity level with low suspicion for [[CNS (Central Nervous System) Infection]]. Patient wearing mittens_, no excessive tearing or redness, and without long nails with low suspicion for [[Corneal Abrasion]]. No overt evidence of NAT or hair tourniquets. No malignant rashes noted and improving [[Diaper Rash]] per parents on exam. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of [[CNS (Central Nervous System) Infection]] including but not limited to changes in mental status or vomiting, or fever. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.	
presenting with 3 days_ of vomiting and [[Diarrhea]]. Currently [[(Iso;Eu)volemia]] without any abdominal tenderness or peritoneal signs. Nontoxic appearing; query possible [[Gastroenteritis]]. Patient also with URI symptoms and a cough over past several days – suspect viral etiology and will low suspicion for pneumonia at this time_. Nausea control, rehydrate, serial abdominal exam, reassess. At this time, given initial history and exam, low suspicion for torsion, PID, atypical [[Appendicitis]] or [[Cholecystitis]].	
not on [[Anti-Coagulation]]_ with resultant laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] updated. NVI distally. Relatively clean wound, irrigated copiously and repaired in simple fashion with dermabond. No antibiotics indicated at this time. Given mechanism and nonfocal neurologic exam, low suspicion for ICH or significant c-spine injury. Discussed strict return precautions and [[Wound Care]].	
otherwise healthy with moderate risk HIV exposure (unprotected vaginal sex with HIV+ patient albeit with unclear last CD4 + VL)_. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]]/C, RPR, G/C and HIV and relative rates given source patient and mechanism. Patient declining vaginal exam to evaluate for tears at this time after risks discussed with full understanding and capacity. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given risk of transmission, mutual [[Decision Making]] to use PEP at this time. Discussed prompt follow up with clinic for bloodwork and serial serologies. Discussed at length regarding consensual nature of sex and patient does not feel that encounter was not consensual. Discussed that if patient changes mind, given STI treatment center resources. Patient contracts to safety and feels safe at home.	
Given history, per CDC (2013) and NYSDOH (2014), patient not pregnant and will treat with Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Either Raltegravir 400 mg PO twice daily. Discussed post exposure testing at baseline6 weeks post-exposure, 12 weeks post-exposure. 6 months post-exposure at clinic. Will provide 5 days of PEP_ but discussed prompt need for follow up and full course being at least 4 weeks. Cautious return precautions discussed w/ full understanding.	
subacute worsening of chronic [[Right Knee Pain]]. Atraumatic. Neurovascularly intact distally. Given [[Focal Tenderness]], query possible MCL strain vs [[Bursitis]]. No systemic symptoms and nontoxic; given exam and history, low suspicion for [[Septic Arthritis]], pyomyositis or [[NF (Necrotizing Fasciitis)]]. No e/o [[Compartment Syndrome]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].	
MDMKneePainTrauma	
with R_ knee pain and mild swelling after injury. Neurovascularly intact distally. Given [[Focal Tenderness]], query possible ligamentous injury however no gross instability. No tibial plateau tenderness. XR without frank fracture. Low suspicion for [[Vascular Injury]] with dislocation-relocation. No ankle or [[Hip Pain]]. No [[Back Pain (Dolor)]] with low supicion for significant axial load. No systemic symptoms and nontoxic; given exam and history, low suspicion for [[Septic Arthritis]], pyomyositis or [[NF (Necrotizing Fasciitis)]]. No e/o [[Compartment Syndrome]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]. [[Pain Control]]. Follow up with PMD and ortho as needed. Cautious return precautions discussed w/ full understanding.	
with chin injury and superficial arm abrasions s/p fall from scooter_ prior to arrival. Pt with resultant chin laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] UTD. No maloccusion with low suspicion for mandibular fracture. No LOC and low suspicion for ICH. Relatively clean wound, irrigated copiously and repaired in simple fashion with sutures. No antibiotics indicated at this time. Discussed strict return precautions, follow up for suture removal and [[Wound Care]]. Extremity exam with full range of motion, no [[Bony Tenderness]] and distally neurovascularly intact.	
with resultant laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] updated. XR w/o overt e/o fracture. NVI distally. Relatively clean wound, irrigated copiously and repaired in simple fashion with staples_. No antibiotics indicated at this time. NVI per routine post repair. No overt e/o [[Compartment Syndrome]]. Discussed strict return precautions, follow up for staple removal and [[Wound Care]].	
with history of chronic intermittent [[Migraine (Headache)]], recently started on triptan_, now presenting with similar [[Constellation]] of symptoms without overt evidence and low suspicion for [[ICH (Intracranial Hemorrhage)]], [[SAH (Subarachnoid Hemorrhage)]], or CNS affection. Patient with non-focal neuro exam. Patient not immunocompromised and no family history of bleeding dyscrasias or aneursymal rupture. Headache slow onset and similar to prior exacerbations. Will attempt [[Pain Control]], serial neuro exams, and reassess.	
otherwise healthy involved in restrained MVA with airbag deployment. Patient with pain predominantly to L paraspinal and L [[Clavicular]] area_. [[Hemodynamic]]ally appropriate with nonfocal neurologic exam. Given exam and history, low suspicion for traumatic dissection or ICH. CT c-spine without overt fracture or dislocation with low suspicion for ligamentous injury on re-examination. Serial abdominal exam without tenderness and FAST initially unremarkable. Observed for several hours in ED with clinical improvement. Stable gait and tolerating PO. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
with no pertinent history presents with now resolving R_ paraspinal neck pain. No acute findings on exam; in particular, no midline spinal tenderness to palpation. Non-focal neuro exam with sensation and strength intact and equal bilaterally. Low suspicion for cervical ligamentous or [[Vascular Injury]]. Intact grips and UE exam with low suspicion for central cord. Discussed [[Pain Control]], observation of symptoms. Cautious return precautions discussed w/ full understanding.	
Patient denies severe mechanism of injury.	
Patient does not have overt evidence of abdominal wall trauma or [[Seatbelt Sign]].	
Patient is currently alert and at baseline mental status and activity level per family.	
Patient denies any abdominal tenderness and does not have evidence of thoracic wall trauma.	
Breath sounds remain equal bilaterally.	
Denies nausea or vomiting.	
with vaccinations up to date_, full term, otherwise healthy boy presenting with fever and [[Constellation]] of upper respiratory symptoms. Currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing [[(Iso;Eu)volemia]]. Mild fever and well appearing after [[Ibuprofen; ((ADVIL), (MOTRIN))]] administration. No meningismus, otherwise at baseline activity level with low suspicion for [[CNS (Central Nervous System) Infection]]. Query likely viral etiology. Discussed low risk but possible UTI and offered catherterized urine sampling, but mutual [[Decision Making]] at this time to defer after discussion with parents_. Discussed alternating tylenol and [[Ibuprofen; ((ADVIL), (MOTRIN))]] as directed over the counter for antipyresis. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of [[CNS (Central Nervous System) Infection]] including but not limited to changes in mental status or vomiting, or fever for more than 5 days. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.	
[[Immunization]]s UTD_, otherwise healthy, not immunocompromised, presenting with fever and [[Malaise]]. [[Constellation]] of symptoms and history concerning for possible UTI_. Patient is extremely well appearing, mentating well, at baseline per parents, lucid and without meningismus. Nonfocal neuro exam with low suspicion for [[CNS (Central Nervous System) Infection]]. No [[Respiratory Distress]] with low suspicion for pneumonia. No [[Abdominal Pain]] and benign abdominal exam with low suspicion for atypical [[Appendicitis]]. No overt findings for vulvovaginitis_. UA with some WBC and + LE_. Given symptoms, will treat with [[Cephalexin (KEFLEX)]]_ for possible upper tract infection. Tolerating PO including juice and crackers in ED. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. [[Appendicitis]] return precautions discussed.	
with positional chest pain for the past 2 days_. Recent mild cough, [[Sore Throat (Pharyngitis)]]_. EKG obtained consistent with [[Pericarditis]]. BUS w/o overt tamponade or significant effusion. Query possible [[Recent [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]]]] as trigger. No overt e/o AKI or CKD, malignancy, HIV, TB. No overt high risk factors for complicated [[Pericarditis]] including fever, no e/o large [[Pericardial Effusion]] or tamponade, no immunosuppression, [[Anti-Coagulation]], or trauma. Low suspicion given history and exam for concurrent [[Myocarditis]], ACS or PE. Discussed activity restriction until symptom resolution. Discussed treatment with [[NSAID (Non Steroidal Anti Inflammatory Drug)]] ([[Ibuprofen; ((ADVIL), (MOTRIN))]] TID per ESC guidelines) with low risk for GIB (no history of PUD, age < 65, and no concurrent [[Anti-Coagulation]]) and cotreatment with [[Colchicine (MITIGARE, COLCRYS)]] given lack of risk factors for toxicity (low suspicion for CKD given age) and potential benefits (significant reduction in the risk of recurrence – ICAP trial NEJM 2013)_. Discussed need for close follow up with ASHE and cardiology referral as well as strict return precautions for worsening chest pain, signs of [[CHF (Congestive v[[HF (Heart Failure)]])]]/fluid overload/tamponade, or infection.	
presenting with increased anxiety with clear trigger now resolved. Given exam and history, low suspicion for acute cardiopulmonary process including dissection, ACS, or PE. Denies any acute ingestions and denies any other medical complaints at this time. Does not endorse any [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Engages with conversation. Mood and affect are congruent. Thoughts are linear and organized, and has no AH or HI. No acute need for psychiatric consultation and patient without SI or HI. Clinically no overt toxidrome, well appearing, low suspicion for ingestion given history and exam. Contracted for safety as well as demonstration of significant insight for finding homeless shelter and follow up. Cautious return precautions discussed w/ full understanding.	
fully immunized, otherwise healthy, p/w isolated rash likely due to viral exantham_ given history, temporal nature and appearance. No mucous membrane involvement with low suspicion for SJS/TEN. No [[Wheez(-e -es; -ing)]] or difficulty breathing with low suspicion for systemic involvement. Low suspicion for scabies given history and exam. Discussed close monitoring for progression. Cautious return precautions discussed w/ full understanding. No overt e/o superinfection. Prompt follow up with primary care physician discussed.	
MDMScabies	
subacute rash over months_. Given distribution, characteristics and associated symptoms, likely secondary to scabies vs bedbugs. No overt mucosal involvement w/ low s/f TEN/SJS/EM. No e/o superinfection. Discussed hygiene/de[[Contamination]] measures, continue ivermectin and [[Permethrin]]_; symptomatic t/w [[Diphenhydramine (BENADRYL®)]] and steroid burst. F/u w/ dermatology as discussed. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
s/p [[Renal Transplant]]_ and s/p OHT_ who presents with fever for past several days and intermittent [[Productive Cough]]_. Despite patient being well appearing, will perform septic workup with concern for possible CAP. Will obtain CXR, labs, blood cultures, urine cultures, UA. Will also get troponin (to evaluate for [[Myocarditis]]), [[BNP; BNF (Brain Natriuretic (Factor; Peptide))]] (to trend for possible rejection). No overt evidence of fluid overload at this time. No overt hospital acquired risk factors but given immunosuppression and concern for pulmonary cause, will empirically treat with vanc/[[Cefepime (MAXIPIME, VOCO)]]/[[Azithromycin (ZITHROMAX, Z-PACK)]]_ and will defer to medicine team to narrow. Although grafts working well on prior visit, as patient not overtly septic, will gently hydrate with NS given [[Hemodynamic(ally) (Stability, Stable)]] and propensity for possible graft dysfunction/fluid overload_.	
who presents with fever and ¾_ [[Systemic Inflammatory Response Syndrome (SIRS) Criteria]]. Resuscitation via EGDT with 30 cc/kg NS bolus with stabilization in vitals. Empiric [[Antibiotic Therapy]], albeit with modified regimen given suspected intraabdominal source_ and allergy profile_. CXR, cultures, and UA. Consider [[NE (NoreEpi, Norepinephrine, Noradrenaline LEVOPHED)]] if patient not fluid responsive. Monitor [[Hemodynamic]] status. Admit to medicine for further care.	
with history of SSD Hb SS_, functionally asplenic_, [[Immunization]]s for encapsulated organisms reportedly up to date, complicated prior by_ [[Avascular Necrosis]] of humerus and femur, and [[Acute Chest Syndrome]]_, last transfusion several months prior_, baseline hgb _ now presenting with [[Constellation]] of symptoms similar to prior acute vasooclusive pain crises without overt trigger. Patient is afebrile, not hypoxic and without [[Dyspnea]] with low suspicion at this time for [[Acute Chest Syndrome]]. Will trend [[Hb (Hemoglobin)]] and [[Reticulocyte Count]] to evaluate for possible hemolytic vs aplastic crisis, although low suspicion at this time. No overt worsening of [[Avascular Necrosis]] or [[Osteomyelitis]] on exam. Nonfocal neuro exam with low suspicion at this time for end [[Organ Dysfunction]] from VOC including CVA, ACS, AKI or hepatobiliary complications. Will continue to monitor, [[Pain Control]], gentle hydration, and follow up labs.	
MDMStye	
with stye vs chalazion to right upper eyelid. Patient well appearing without overt evidence of septal or pre-septal cellulitis. No overt evidence of [[CST (Cavernous Sinus Thrombosis)]]. Will discharge with recommended warm compresses at home and optho follow-up this week. Low suspicion for [[Foreign Body]] or [[Corneal Abrasion]] given history and exam.	
who presents with syncope prior to arrival. Witnessed syncope, likely vasovagal in etiology given history and exam. Patient currently at baseline mental status. No chest pain with low s/f dissection or ACS. No hypoxia or tachypnea with no risk factors for PE. No overt e/o malignant [[Arrhythmia (Abnormal Rhythm)]] on serial EKG. Patient not pregnant_. PO challenge. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed for further workup as needed.	
with otherwise healthy, fully vaccinated with [[Sore Throat (Pharyngitis)]] likely secondary to viral URI vs [[[[Strep(tococc(us;I;al))]] Pharyngitis]]. No [[Tetanus (Tetany; Trismus; Lockjaw)]] on exam and no overt e/o PTA or RPA. No overt e/o deep space infection; nontoxic appearing and tolerating PO. Centor _. Non-focal neuro exam with low suspicion for [[Lemierre Syndrome]]. Trial antibiotics and [[Steroid]] with cautious return precautions discussed w/ full understanding. Tolerating PO and otherwise well appearing.	
MDMURI	
otherwise healthy presenting with [[Constellation]] of symptoms likely representing uncomplicated viral upper respiratory symptoms as characterized by mild [[Sore Throat (Pharyngitis)]] without overt evidence of RPA/PTA, deep space infection/[[Ludwig Angina (Dental Sepsis)]]’s, or bacterial superinfection_. Low suspicion for [[CNS (Central Nervous System) Infection]] bacterial sinuitis, or pneumonia given exam and history. Will attempt to alleviate symptoms conservatively; no overt indications at this time for antibiotics. No [[Respiratory Distress]], otherwise relatively well appearing and nontoxic. No peritoneal signs with low suspicion for acute intraabdominal process. Will discuss prompt follow up with PMD and strict return precautions discussed.	
MDMUTIMale	
with with no significant medical history who presents with UTI without overt e/o infected stone or prostatitis. BUS w/o overt e/o [[Hydronephrosis; Ureterectasis (Hydro;Ureter(o));(nephrosis;ectasis))]]_. Rectal w/o e/o abscess formation, deep space infection or prostatitis_. No e/o [[Epididymo-Orchitis]] on exam. Abdomen benign with minimal suprapubic TTP. No CVAT. Febrile, but otherwise well appearing and reliable. Given dose of [[Ceftriaxone (ROCEPHIN)]] and d/c w/ Cipro_. Cautious return precautions discussed w/ full understanding. [[Appendicitis]] and [[Abdominal Pain]] precautions given for return. Prompt follow up with primary care physician discussed.	
[[PE (Physical Exam(ination))]]	
PEAnkle	
NVI per routine with appropriate cap refill, extension and flexion of digits, sensation intact to FT throughout	
No pain over 1st and 5th MTP	
No medial or lateral malleolar tenderness	
No proximal tib/fib pain	
(+) small _ cm abscess over interdental papilla of right lower premolar_ between teeth 29 and 30_ with mild gingival thickening, otherwise gingival tissues pink and stipple and firm. No discharge, no blood visualized.	
Otherwise, patient with no exudate to bilateral tonsillar beds and no erythema to upper palate or tonsillar beds. No uvular deviation. Full range of motion of neck. No evidence of overt RPA or PTA on exam. Non-elevated [[Tongue]] with soft lower palate. No [[Carotid Artery Bruit]] heard in neck. No petechiae around face or neck. No LAD appreciated. Supple.	
Comfortably resting, lying in bed, NAD, non[[Sweating]], lucid, fully conversant, no [[Respiratory Distress]], alert and oriented.	
Testicular exam with normal lie and CMR bilaterally, no significant erythema, tenderness or swelling appreciated. No appreciable [[Inguinal Hernia]] bilaterally. No rashes or lesions. No penile discharge. No blood at meatus.	
PEHand	
2+ RP symmetric bilaterally. CR < 2 seconds bilaterally. Neurovascularly intact to radian, median, ulnar per routine to both fine touch and motor in distal hands.	
Right hand:	
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.	
Left hand:	
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.	
PEHeadTrauma	
No [[Septal hematoma]], TM x2 clear w/o e/o hemotypanum or CSF rhinorrhea, no [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], [[Raccoon eyes]] or csf rhinorrhea, no e/o entrapment, no diplopia on EOM, PERRL, EOMI. No facial tenderness over zygoma, mandible or maxilla. No malocclusion or [[Tetanus (Tetany; Trismus; Lockjaw)]]. TMJ grossly intact. Midface stable. Nose midline without significant deviation. No ML C-spine TTP.	
PEKnee	
Full range of motion of right ankle, right knee without pain, (-) right [[Patellar]] tenderness. Negative mcburney’s, negative Lachman’s, [[Posterior Drawer Test]]. 5/5 strength of ankle, knee and hip with stable gait. No effusion appreciated.	
PELowerExtremity	
No [[Lower Extremity Edema]], asymmetry, erythema or pain. 2+ DP.	
Mental status: oriented, alert, lucid, cooperative, appropriate.	
Cranial nerves: [[CN 2 (Cranial Nerve (Two; II); Optic)]]-12 intact	
Motor: 5+ UE and LE, flexors and extensors symmetric.	
Sensation: Grossly intact to fine touch UE and LE symmetrically.	
Cerebellar: normal FTN bilaterally. No tremor noted.	
Gait: normal gait	
Tone: normal bulk and tone in upper and lower extremities. No atrophy noted.	
Visual Acuity:	
OD: 20/20	
OS: 20/20	
OU: 20/20	
No pinhole, no lens	
Pupils:	
OD: 4à2	
OS: 4à2	
APD: none	
[[IOP (Intraocular Pressure; 10–20 mmHg)]] –	
Tp OD: 15	
Tp OS: 15	
Extraocular motility: FULL OU	
Confrontational fields: intact in all fields OU.	
[[Slit Lamp]] exam:	
Lids and lashes: No edema and no periorbital erythema	
Conjunctiva and Sclera: no injection OU	
Cornea: no stromal edema, no ED OU	
[[Anterior Chamber]]: no cell, no flare OU	
Iris: round and reactive OU	
Lens: IOL OU	
PEPEDSGEN	
At baseline, well appearing, smiling, interactive, playing with mother. Nontoxic appearing. No tripoding, no drooling. Verbalization at baseline.	
12.PEPULM	
No overt [[Respiratory Distress]]. No tripoding or [[Accessory Muscle Use]]. No cyanosis. No clubbing. No stridor or audible [[Wheez(-e -es; -ing)]]. No visualizable [[Foreign Body]] or mass in [[Upper Airway]].	
Full range of motion of left ankle_, (+) _ [[Patellar]] tenderness. 5/5 strength of left ankle, knee and hip but limited by pain. Possible small knee effusion on ballotment_. Mild erythema over anterior superior knee _. No pain [[Out of proportion]]; area traced out and observed throughout ED stay without extension. No pain on axial loading. Passive and active ROM to 120 degrees without significant discomfort. + TTP over area of erythema w/o fluctuance. 2+ DP.	
No tenderness to shoulder, no limited flexion and abduction of shoulder secondary to pain, rotator cuff tests are negative. Able to touch opposite shoulder with hand. No deformities. Radian, medial, and ulnar nerves intact to motor and sensation. Good distal pulses and good cap refill.	
There is no bruising and no laceration of the skin. The clavicle is not elevated, and the skin is not tented. No sulcus sign when palpating the [[Humeral Head]] and scapula. No scapular tenderness. He has intact [[Axillary Nerve]] sensation. He has no pain or limitation to ROM of elbow, or wrist. He has intact motor distal but limited ROM of the shoulder due to pain.	
PEThroat	
Patient with no exudate to bilateral tonsillar beds and no erythema to upper palate or tonsillar beds. No uvula deviation. Full range of motion of neck. No evidence of overt RPA or PTA on exam. Non-elevated [[Tongue]] with soft lower palate. No [[Tetanus (Tetany; Trismus; Lockjaw)]]. No [[Carotid Artery Bruit]] heard in neck. No petechiae around face or neck. No LAD appreciated. FROM, supple.	
PEAllergicDermatitis	
(+) blanching [[Nontender]] mildly pruritic maculopapular centrally confluent rash with satellite lesions over _. Negative nikolsky’s. No perineal, scrotal or mucosal involvement_. No discharge or crusting.	
No TTP over C/T/L/S midline	
Diffuse nonconfluent pinpoint erythematous blanching [[Papular Rash]] predominately over thorax, extremities_. Pruritic, [[Nontender]], non discharge, some with overlying excoriations without evidence of cellulitis or superinfection. No tenderness to palpation. Negative nikolsky’s. No predominance over flexor creases. No involvement of nails or web spaces of hands.	
Pelvic Exam: Closed Os, no purulent mucopurulent cervical exudate. no cervical friability, no cervical erythema, edema. No Adnexal Tenderness, no CMT. No [[Vaginal Vault]] Discharge or lacerations.	
History and Physical	
HPIBackPain	
Patient has no history of malignancy, active or distant history. Patient is not less than 16 or greater than 50. Patient has no unexplained weight loss. No recent fevers, rigors, [[Malaise]], or recent infection. No history of [[IVDU; IVDA (IV (Intravenous) Drug Abuse)]] or skin-popping. Patient does not have any [[Saddle Anesthesia]]/[[Perianal]] sensory loss or complaining of [[↓ Rectal Tone]]. Patient does not have [[Urinary Retention]] or inability to control urine from overflow. Patient has no tenderness overlying spinous process. Patient has normal gait and able to walk on heels/ toes. Patient has no focal weakness on examination. Patient does not have hyperreflexia on examination.	
HPIChestPain	
Patient has a history significant for _.	
[[Chest Discomfort]] is described as a pressure/sharp/dull sensation without/with radiation to neck/arm/back. Patient has had this chest pain before. Chest pain is nonexertional. Chest pain started at _ and has been intermittent/constant/progressive/nonprogressive. Patient last chest pain was at _.	
Chest pain is non-pleuritic and not positional_. Chest pain is not associated with food.	
Patient endorses the following symptoms: _	
Patient denies any associated symptoms, including [[Near Syncope]], syncope, palpitations, [[SOB (Shortness of Breath)]], nausea, vomiting, [[Sweating]]._	
Denies [[Orthopnea ([[SOB (Shortness of Breath)]] (dyspnea) That Occurs When Lying Flat)]], PND, or LEE.	
Denies upper respiratory symptoms or [[Productive Cough]].	
Patient denies any [[Lower Extremity Edema]], pain, asymmetry, or swelling.	
Denies prior [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]/PE or history of malignancy or known [[(Hypercoagulable; Prothrombotic) (State; Disorder; Condition) (Thrombophilia)]].	
Patient has had no decline in their exercise tolerance.	
Patient denies any tearing chest pain.	
Patient denies any early family history of cardiac death or MI.	
Patient has been compliant with home medications	
HPI5Ds	
No [[Dysphagia]], [[Dysarthria]], diplopia. No difficulty with gait or coordination.	
HPIAMS	
_ presents with [[AMS (Altered Mental Status)]].	
Patient’s history is notable for: _.	
Patient was brought in by _. Patient was found at _.	
Denies ingestion. _	
Patient without history of similar in past._	
Glucose in field was _.	
Denies seizure history. No seizure activity witnessed. Denies incontinence or [[Tongue]] biting._	
Denies falls or recent trauma._	
HPIAbdominalPain	
Patient presents with [[Abdominal Pain]].	
Patient’s history is notable for: _.	
Patient first noted the [[Abdominal Pain]] _. Pain is at diffuse/RUQ/LUQ/RLQ/[[LLQ (Left Lower Quadrant)]]/epigastric _. Discomfort is described as a pressure/sharp/dull_ sensation without/with _ radiation to groin/back. Patient has had this [[Abdominal Pain]] before_. Pain is nonexertional and not positional_.	
Pain is not associated with food_. Pain is alleviated by _ and worsened by _.	
Patient denies past abdominal surgeries. Last [[Bowel Movement]] was _. Endorses flatus._	
Denies nausea or vomiting. Able to tolerate PO without difficulty._	
Denies [[Diarrhea]], [[BRBPR (Hematochezia; Bright Red Blood Per Rectum)]], or [[Melena (Dark Tarry Stool)]]._	
Denies [[Dysuria]] or [[Hematuria]]. Denies flank pain. _	
Denies recent travel._	
Denies recent antibiotics or hospitalizations._	
vaccinations up to date_, full term, otherwise healthy boy_ who presents with upper respiratory symptoms including a non[[Productive Cough]], congestion and [[Coryza]] for 2-3_ days. Patient also with fever for 2 days_. Endorse sick contact_ in father with similar symptoms. Stable UOP. No nausea or vomiting. Normal PO intake. No rashes. At baseline mental status and activity level without [[Lethargy]]. No recent travel. No overt [[Abdominal Pain]], headache, ear pain, or [[SOB (Shortness of Breath)]]. No increase in respiratory effort.	
Patient is asymptomatic currently and at baseline_. Patient was seen in clinic today by primary OB and patient had two mildly [[↑↑↑ [[BP (Blood P (Pressure))]] ↑↑↑]] readings_. Patient denies known personal and family history of [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]]_. Denies headache or vision changes, including [[Photophobia]], [[Blurred Vision]], and [[Scotoma(ta); [[Visual Field(s)]] (Defect; Deficit)]]. Denies [[Abdominal Pain]], nausea, vomiting, focal weakness or parasthesias. Endorses persistent, although stable, intermittent [[Lower Extremity Edema]] without further asymmetry or pain. Denies chest pain or [[SOB (Shortness of Breath)]]. Denies PND or DOE. Denies oozing with brushing teeth or new easy bruising. Denies [[Vaginal Bleeding]], loss of fluid, [[Contractions]]. Endorses stable and active movement of fetus.	
_who presents with SI_.	
Patient’s history is notable for: _. Patient was brought in voluntarily/by family/by police_. A temporary hold was/was not placed prior to arrival. _	
Patient was in normal state of health until approximately _ days ago. At this time, patient noted _. Patient came in today due to _.	
Patient endorses SI with plan to _.	
Denies previous suicide attempt. Patient has been compliant with his medications._	
Patient denies any ingestions including tylenol or aspirin._	
Denies [[Illicit (Substance; Drug) (Use)]] including [[IVDU; IVDA (IV (Intravenous) Drug Abuse)]], [[Amphetamines]], [[Marijuana (Cannabis)]], or alcohol. _	
Patient is seen by Dr. _.	
Denies previous hospitalizations._	
Denies [[Hallucinations]], auditory or visual._	
Denies HI/HA._	
Patient is able to perform daily functions and contracts to safety._	
HPIPEDSRash	
fully vaccinated, otherwise healthy M_ who presents with rash for past day_. Rash started centripetally_ and is scattered papular mildly pruritic over chest and face_ with no oral involvement. Patient with mild URI symptoms several days prior and fever, now resolved. Patient otherwise at baseline with baseline mental status, activity level, UOP and PO intake intact. Denies sick contacts. Denies other family members with rash. Denies discharge, fevers, recent travel/hospitalizations/antibiotics.	
HPISOB	
presents with [[SOB (Shortness of Breath)]]. Patient’s history is significant for _.	
Patient first noticed increased [[SOB (Shortness of Breath)]] _. [[SOB (Shortness of Breath)]] has been progressive_. Denies alleviating or exacerbating factors_. Denies similar episodes in past. Denies changes in position. Denies pleurisy.	
Denies chest pain, [[Abdominal Pain]], nausea or vomiting. Denies fevers._	
Denies home oxygen requirement or increase in oxygen requirement._	
Denies recent travel. Denies sick contacts_.	
Denies upper respiratory symptoms, including [[Productive Cough]], [[Hematemesis]], [[Sore Throat (Pharyngitis)]] or runny nose._	
Denies [[Lower Extremity Edema]], swelling, asymmetry or pain._	
Denies history of [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]/PE. Denies known malignancy or [[(Hypercoagulable; Prothrombotic) (State; Disorder; Condition) (Thrombophilia)]].	
Denies smoking or OCP use.	
Patient has been compliant with home medications.	
otherwise healthy p/w four_ days of [[Productive Cough]] without [[Hemoptysis]], mild chills now resolved, no overt fever, also associated with concurrent [[Coryza]] and congestion_. Denies chest pain or [[SOB (Shortness of Breath)]]. Denies LE edema, asymmetry or pain. Denies AP, n/v. Denies headache, fevers or chills. Denies [[Orthopnea (Shortness of Breath (dyspnea) That Occurs When Lying Flat)]] or PND. + sick contact also with similar [[Constellation]] of symptoms. No travel.	
Progress Notes	
PROGAlcohol	
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient with increased lucidity, tolerating PO, interactive with staff. [[Hemodynamic(ally) (Stability, Stable)]].	
Trialed gait after several hours of observation in the ED with improvement in mental status to baseline and with stable gait. Cautious return precautions discussed w/ full understanding.	
PROGAMA	
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.	
PROGAnkle	
X-ray does not reveal any fractures, likely ankle sprain. Discussed discharge instructions with parents and return precautions. Parents expressed verbal understanding and agreement with care plan. All questions answered. Given crutches and an ankle brace. Patient is well-appearing, in no apparent distress, and vital signs stable for discharge home.	
PROG[[Asthma]]	
Patient reassessed and respiratory status has stabilized while in the department and appears appropriate for outpatient work up. Exam and work up not consistent w/ impending [[Respiratory Failure]] or cardiovascular collapse. Afebrile with low suspicion for acute pneumonia. Patient not hypoxic, fully ambulatory without [[Respiratory Distress]]. Medications refilled and strict return precautions discussed.	
PROGECG	
EKG reviewed, no overt evidence of contiguous [[ST (Segment) Elevation]]s, low suspicion for acute MI. No overt tachy- or brady[[Dysrhythmia]]s. Low suspicion for [[WPW (Congenital Pre-Excitation Syndrome; Wolff-Parkinson-White)]], [[QT Interval (Segment) Prolongation]], [[HOCM (Hypertrophic Obstructive Cardiomyopathy)]], [[Brugada Syndrome]] after EKG review.	
As above, patient with unchanged neurovascular exam post procedure. No [[Foreign Body]] sensation after repair but discussed possible smaller fragments being retained despite close inspection under bright field and copious irrigation with saline_. Cautious return precautions discussed w/ full understanding.	
After extensive discussion with family regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time_. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Patient with nonfocal neurologic exam and with low suspicion for overt [[ICH (Intracranial Hemorrhage)]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.	
Serial neuro exam without new focal neuro signs or [[AMS (Altered Mental Status)]], has been at baseline mental status; seen running and walking around ER smiling and playful. No emesis. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]]. Discussed case at length with parents and requesting to go home. Given reliability of parents (both father, mother, and grandmother at bedside with appropriate concern and interaction), low suspicion for NAT and seems reliable to monitor and bring back patient if any changes or concerns. Mutual decision to discharge home with strict return precautions.	
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]].	
This was assessed during the medical interview. Capacity to make one’s own medical decisions is based upon a patient’s ability to understand the decision that is being made, the possible options, the risks and benefits of those options, demonstrate understanding of this information and the ability to apply it to themselves, and ultimately the ability to communicate a decision. Capacity is dynamic over time, and the threshold for capacity is different dependent on the specific decision and its risks and benefits. Given our conversation, the patient at this time does appear to have the ability to communicate a preference to leave the hospital rather than stay and have medical workup_. The patient does understand the benefits of their decision, which include personal [[Autonomy]] and the ability to seek care elsewhere, as well as the risks, which include delay in medical workup and possible worsening of symptoms. Given their ability to reason through this decision, and the risk of leaving the hospital _, the patient does appear to have capacity at this time_. Therefore, we will respect the patient’s [[Autonomy]] to make their own decisions, which at this time is expressed as a desire for discharge.	
Of note, at this time, it the patient does not seem to meet criteria for an in[[Voluntary]] hold based on grave disability. Patient is able to state a clear and viable plan for obtaining her own food, clothing, and shelter._	
Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
PROGPEDSHeadTraumaReassess	
Serial neuro exam without new focal neuro signs or AMS, has been at baseline mental status; seen running and walking around ER smiling and playful. No emesis. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]]. Discussed case at length with parents and requesting to go home. Given reliability of parents (both father, mother, and grandmother at bedside with appropriate concern and interaction), low suspicion for NAT and seems reliable to monitor and bring back patient if any changes or concerns. Mutual decision to discharge home with strict return precautions.	
ED Sign Out	
The patient’s care was signed out to Dr. * at 20:00*.	
Items Pending at sign out: ***	
Impression at the time of sign out: ***	
Expected disposition: ***	
(I spoke to the physician taking over care about the plan for this patient, but the final disposition will depend on the results of the patient’s studies/labs and condition upon re-evaluation. The original plan may alter depending on the patient’s medical needs.)	
Discharge Instructions	
DCAbdPain	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Abdominal Pain]]. Your evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of your current condition.	
Return to the ER if your pain does not resolve within 8-12 hours or worsens. Please follow up with your primary care physician within one to two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], chest pain, difficulty breathing, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for your allergic reaction. You have been given medications including [[Steroid]], [[Epinephrine (Adrenaline)]], and [[Diphenhydramine (BENADRYL®)]] to control your swelling. You have been observed in the Emergency Department and it appears that your symptoms will not return.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience difficulty breathing or swallowing, recurrent vomiting, rashes, lip/mouth/[[Tongue]] swelling, persistent fevers or for any other concerning symptoms.	
Thank you for choosing Olive-ViewUCLA for your care.	
DCAbscessID	
You were evaluated in the Olive View-UCLA Emergency Department for an abscess. Your abscess was incised and drained in the Emergency Department. We have inserted a loose gauze in the abscess pocket to promote drainage and applied a clean dressing over it. You will need to change the dressing every 24 hours. Please keep the areas surrounding the abscess clean and dry. Take the antibiotics prescribed to you in full as directed.	
Follow up with your primary care physician within 2 days for a wound check. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, an increase in area of redness, increased tenderness/warmth around the abscess, [[Foul Smelling]] discharge from the abscess, or any other concerning symptoms.	
DCAbscessNoID	
You were evaluated in the Olive View-UCLA Emergency Department for an abscess. You should soak the area in warm water for 20-30 minutes 3-4 times daily. Contact your doctor when the abscess comes to a head and needs to be drained. Please keep the areas surrounding the abscess clean and dry. Take the antibiotics prescribed to you in full as directed.	
Follow up with your primary care physician within 2 days for a wound check. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, an increase in area of redness, increased tenderness/warmth around the abscess, [[Foul Smelling]] discharge from the abscess, or any other concerning symptoms.	
DCAMA	
You have been evaluated in the Olive View-UCLA Emergency Department today. You are refusing further testing, imaging, and further admission and choosing to leave [[AMA (Against Medical Advice)]]. You were advised of your risks of leaving and understand that permanent harm, or even death, can occur from failing to follow the recommendations of the physician.	
Please follow up with your primary care physician within one day. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.	
Return to the Emergency Department immediately if you experience worsening or uncontrolled pain, persistent fevers, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], chest pain, [[SOB (Shortness of Breath)]], or for any other concerning symptoms.	
DCAnkle	
You have been evaluated in the Olive View-UCLA Emergency Department today for ankle pain. The x-ray of your ankle _.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your ankle to control your pain.	
Please follow up with your primary care physician within two days as needed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.	
DCAnxiety	
You have been evaluated in the Olive View-UCLA Emergency Department today for your anxiety. Your symptoms have resolved in the Emergency Department.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience new or worsening anxiety, depression, thoughts of harming yourself or others, or for any other concerning symptoms.	
DC[[Asthma]]	
You were evaluated in the Olive View-UCLA Emergency Department today for an acute exacerbation of your [[Asthma]]. Your symptoms improved receiving an albuterol breathing treatment.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms.	
DCBackPain	
You were evaluated in the Olive View-UCLA Emergency Department today for [[Back Pain (Dolor)]]. Your evaluation suggests no acute abnormalities which require further intervention at this time.	
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain. You should continue doing back exercises which could include going to [[Physical Therapy]].	
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening [[Back Pain (Dolor)]], incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.	
DCCellulitis	
You have been evaluated in the Olive View-UCLA Emergency Department today for a skin infection. Please take the prescribed antibiotics as directed for the full course of the medication.	
Follow up with your primary care physician within 2 days for a re-evaluation of the skin infection to make sure it has not spread and is getting better. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience an increase in area of redness, persistent fevers, increased tenderness/warmth around the skin infection, or any other concerning symptoms	
DCChestPain	
You have been evaluated in the Olive View-UCLA Emergency Department today for chest pain. Your evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your EKG did not show any acute changes.	
Please follow up with your primary care doctor in 2 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening chest pain, palpitations, [[SOB (Shortness of Breath)]], persistent vomiting, [[Fainting]], or for any other concerning symptoms.	
DCCough	
You were evaluated in the Olive View-UCLA Emergency Department today for a cough. Your evaluation suggests _.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening cough, fever, [[SOB (Shortness of Breath)]], recurrent vomiting, [[Lethargy]], or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for your dental pain. Your pain has been controlled with __. Your [[PE (Physical Exam(ination))]] suggests no acute abnormalities which require further intervention at this time.	
Please follow up with your [[Dentist]] tomorrow. Call to schedule an appointment with a [[Dentist]]ry clinic.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, fevers 100.4°F or greater, vomiting, [[Tongue]] swelling, throat swelling, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Dizziness]]. Your evaluation suggests _.	
You have been prescribed _ to help relieve your symptoms. Please take your prescription as directed.	
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, [[Fainting]], or for any other concerning symptoms	
DC[[Dysuria]]	
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take as directed in full_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
You were evaluated in the Olive View-UCLA Emergency Department today for ear pain. Your [[PE (Physical Exam(ination))]] suggests that you have an ear infection_. Please take the antibiotics in full as directed_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience [[HL (Hearing Loss; Deafness)]], discharge from your ear, headaches, fevers, recurrent vomiting, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for elbow pain. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable// reveal a fracture_.	
Please use the sling for comfort_. You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with an orthopedic surgeon in about 1 week. If we referred you to the olive view specialists, please follow up with your appointment. Please call 818-364-3676 if you do not receive a call for an appointment time.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for a [[Nose Bleed (Epistaxis)]]. The bleeding was controlled in the Emergency Department and your examination reveals no active bleeding at this time.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately if you experience worsening bleeding, worsening or uncontrolled pain, difficulty breathing, or for any other concerning symptoms.	
You have been evaluated in the Olive View UCLA Emergency Department today for alcohol intoxication. You are now able to walk on your own and are tolerating fluids/food.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience inability to keep down fluids, worsening or uncontrolled pain, confusion, or for any other concerning symptoms.	
LA Country Drug Abuse and Prevention	
http://publichealth.lacounty.gov/sapc/findtreatment.htm	
Call: 800-564-6600	
You were evaluated in the Olive view-UCLA Emergency Department today for eye redness. Your [[PE (Physical Exam(ination))]] suggests _.	
Call (818)-364-3538 to schedule an appointment with the eye specialist within one week for a repeat [[Eye Exam]]._	
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience discharge from your eye, worsening eye redness, [[Eye Pain]], vision changes, headache, fever, vomiting, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for finger pain. Your evaluation, including [[PE (Physical Exam(ination))]] and x-ray, has revealed that you have a fracture of your _// no evidence of any acute fractures or dislocations_. Your finger was splinted in the Emergency Department_. Keep the splint clean and dry.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience any new or worsening finger pain, [[Numbness]], weakness, [[Discoloration]], fevers, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for foot pain. The x-ray of your foot shows _.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your foot to control your pain.	
Please follow up with your primary care physician within two days as needed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with a podiatrist in about 1 week. You can find an podiatrist by calling (818) 364-3676.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for your injury while _. Your evaluation, including an x-ray of your _, have revealed a fracture of your _. Your __has been splinted in the ER.	
Please rest, ice, and elevate your __to control pain and inflammation. Please take Tylenol of Motrin as needed for pain. Take vicodin for as needed for severe pain. Do not drive or operate heavy machinery while taking vicodin.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with an orthopedic surgeon in about 1 week. You can go to your primary care doctor or follow up with the referral we have given you. Please call (818) 364-3676 if you do not receive a call for your appointment time.	
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Abdominal Pain]]. Your evaluation suggests that your pain is due to [[Gallstone (Cholelithiasis)]]. It is not emergent at this time but it is recommended that you make an appointment at a surgery clinic to be evaluated to have your [[Gallbladder]] removed.	
We will give you a referral to general surgery at olive view. They will call you with an appointment time in the future to discuss elective surgery. P lease call (818) 364-3129 if you do not receive an appointment date.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, fever, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], [[SOB (Shortness of Breath)]], or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for general weakness. Your evaluation, including _, were within normal limits and not suggestive of any emergent condition requiring medical intervention at this time.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for headache. Your evaluation suggests _. Your pain improved with medication.	
Please control your pain by alternating Tylenol and Motrin every 4-6 hours as directed on the package.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]]/tingling, weakness, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your evaluation suggests _.	
You will likely feel a little worse tomorrow due to the trauma please rest and control your pain by alternating Tylenol and Motrin every 4-6 hours as directed on the package. You should avoid contact sports, running, playing video games and studying for long periods of time.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience [[Severe Headache]], vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Hemorrhoid (Pile)]]. You were given a prescription for topical cream_ and stool softeners to help with your symptoms. Use a [[Sitz Bath]] and rest to help control your pain (instructions can be found at http://www.webmd.com/digestive-disorders/sitz-bath). Drink plenty of fluids.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, worsening bleeding in your stool, recurrent vomiting, blood in vomit, [[SOB (Shortness of Breath)]], fevers or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for pain secondary to your hernia. Your evaluation suggests that you do not need any emergent surgery to repair your hernia today.	
Please follow up with your primary care physician within the next week. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please arrange to see a general surgeon for elective surgery through your primary care doctor. If you do not have a primary care doctor, we will refer to surgery here, you will receive a phone call for an appointment time. If you do not get an appointment, you can call Outpatient Surgery Clinic, (818) 364-3129.	
Return to the Emergency Department if you experience worsening pain, fever, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], [[SOB (Shortness of Breath)]], or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for toe pain from an ingrown toe nail.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your foot to control your pain, as well as soak your foot in water 1-2 times daily and place an antibiotic ointment in the corner of your toenail and cover with a bandage.	
Please follow up with a podiatrist to treat your ingrown toenail. You can call 818- 364- 3676 to find a podiatry appointment at Olive View-UCLA.	
Return to the Emergency Department if you experience worsening pain, worsening swelling, fevers 100.4°F or greater, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.	
DCKidneyStone	
You have been evaluated in the Olive View-UCLA Emergency Department today for a [[Nephrolithiasis ((Kidney; Renal) Stone(s))]]. The stone will pass on its own and will be expelled in the urine. Please use the strainer as directed to strain your urine until your stone passes. Please read the information provided to you on discharge.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, fever, painful urination, [[Blood In Urine]], weakness, chest pain, difficulty breathing or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for knee pain. The x-ray of your knee shows_.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your leg to control your pain.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, or any other concerning symptoms.	
You were evaluated in the Olive View-UCLA Emergency Department today for a laceration of your _. Your laceration was closed with sutures_ in the Emergency Department. Please keep the area surrounding the laceration clean and dry.	
Please follow up with your primary care physician in 7-10 days to get your sutures removed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, [[Numbness]], tingling, or any other concerning symptoms.	
DCLegSwelling	
You were evaluated in the UCLA Emergency Department today for leg swelling. Your [[PE (Physical Exam(ination))]] and _ reveal _.	
Please rest and keep your leg elevated. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience [[SOB (Shortness of Breath)]], chest pain, palpitations, nausea/vomiting or any other concerning symptoms.	
STROKE – CODE ACTIVATION	
MDM	
This * patient presents with symptoms concerning for acute CVA versus TIA.*. Other items on the differential include dissection, AMI, [[↓Glucose↓]] or other metabolic derangement such as hepatic/[[Uremic [[Encephalopathy (Altered (Level Of) Consciousness)]]]], medication side effect, or post-ictal [[Todd Paralysis]]. However, presentation most concerning for a CVA. EKG without evidence of STEMI or [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]], fingerstick BS not hypoglycemic, and clinical picture does not suggest other stroke mimic. Plan to workup for acute CVA / TIA.	
Plan: Code stroke protocol, MRI/MRA stroke protocol, stroke labs, Neurology stroke consult	
January 3, 2018 Tagged code stroke, CVA, MDM, neuro, stroke, tia Leave a comment	
SYNCOPE – ADMIT	
MDM	
This * patient presents with symptoms consistent with syncope, most likely due to *. Differential diagnosis includes *reflex syncope (i.e. [[Vasovagal Syncope]]). Low suspicion for orthostatic syncope given lack of dehydration, no evidence of acute life threatening [[Hemorrhage]]. Presentation not consistent with [[Seizure]] given short time course, no postictal state, no seizure activity. Low suspicion for acute neurologic catastrophes to include ICH given lack of trauma, risk factors for bleeding diatheses. Low suspicion for vascular catastrophes to include PE, [[Thoracic Aortic Dissection]], AAA rupture. Presentation not consistent with acute life threatening [[Arrhythmia (Abnormal Rhythm)]], [[Structural Heart (Disease; Defect; Problem)]], electrical conduction abnormalities, or ACS (HEART score: *). However, given age, cardiovascular risk factors, history & physical, will workup and admit to telemetry.	
Plan: labs, troponin, CXR, EKG, serial reassessment	
January 3, 2018 Tagged admit, MDM, neuro, syncope Leave a comment	
SYNCOPE – LOW RISK	
MDMJanuary 3, 2018 Tagged low risk, MDM, neuro, syncope Leave a comment	
UPPER [[Gastrointestinal Bleed]] – GENERAL	
MDM	
This patient with * presents with symptoms concerning for acute, upper [[Gastrointestinal Bleed]], likely secondary to *.	
Differential diagnoses includes [[PUD (Peptic Ulcer Disease)]] (PUD = most common) versus less likely [[Gastritis]] versus [[Mallory Weiss Tear (Syndrome)]] versus AVM. Presentation not consistent with esophageal or gastric [[Variceal Bleed]] or [[Spontaneous Esophageal Rupture]]’s syndrome. Presentation not consistent with other etiologies upper [[Gastrointestinal Bleeding]] at this time. No [[Red Flag(s)]] features or high risk bleeding. No evidence of [[Hemorrhagic Shock]]. Glasgow-Blat[[CHF (Congestive v[[HF (Heart Failure)]])]]ord Bleeding (GBS) score: *. Based on this well validated study, the patient can safely be discharged for outpatient therapy // is “high risk” for needing a medical intervention to include transfusion, [[Endoscopy]] or surgery. Plan to check labs to evaluate the extent of bleeding, including H/H. Will initiate treatment with PPI. No indication for [[Octreotide (SANDOSTATIN)]] or antibiotics given low likelihood of [[Variceal Bleed]] from [[PH (Portal [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]])]] and [[Cirrhosis]].* No indication for abdominal imaging at this time.	
Plan: labs, LFTs, close [[Hemodynamic Monitoring]], serial reassessment, PPI therapy, Octrotide/CTX***	
January 3, 2018 Tagged general, gi, MDM, UGIB, [upper [[Gastrointestinal Bleed]]](https://natedotphrase.com/tag/upper-gi-bleed/) Leave a comment	
UTI – LOW RISK	
This * patient presents with symptoms consistent with acute [[Uncomplicated Cystitis]]. No systemic symptoms. Not septic. Well appearing. Low suspicion for acute [[Pyelonephritis]] given lack of fever, CVAT, or systemic features. Low suspicion for [[Nephrolithiasis ((Kidney; Renal) Stone(s))]] or infected stone. *ICON negative; not consistent with pregnancy, including ectopic. No indication for labs or imaging at this time.	
Plan: UA, UCx, antibiotics***	
January 3, 2018 Tagged cystitis, gu, low risk, [[UTI (Urinary Tract Infection)]]](https://natedotphrase.com/tag/urinary-tract-infection/), uti Leave a comment	
[[Vertigo]] – LOW RISK	
MDM	
This patient presents with [[Dizziness]], most consistent with a peripheral cause, likely [[Vertigo]]. Differential diagnoses includes: BPPV versus labrynthitis.*** No [[Red Flag(s)]] features for [[Central Vertigo]] to include gradual onset, vertical/bidirectional or nonfatigable nystagmus, focal neurologic findings on exam (including inability to ambulate). Presentation not consistent with an acute [[CNS (Central Nervous System) Infection]], vertebral [[Basilar (Artery) Insufficiency]], [[Cerebellar Hemorrhage]] or [[Infarction]], [[Intracranial Mass]] or bleed, [[Temporal Lobe(s)]] epilepsy, [[MS (Multiple Sclerosis; Encephalomyelitis Disseminata)]], trauma, complex [[Migraine (Headache)]] headache. Other acute, emergent causes of [[Vertigo]] are unlikely given at this time. No indication for head imaging at this time.	
Plan: [[Meclizine (ANTIVERT)]], supportive care, serial reassessment	
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Vertigo]]-mdm-low-risk/) Tagged [[[Dizziness]]](https://natedotphrase.com/tag/[[Dizziness]]/), low risk, MDM, neuro, [[Vertigo]]](https://natedotphrase.com/tag/[[Vertigo]]/) [Leave a comment](https://natedotphrase.com/2018/01/03/[[Vertigo]]-mdm-low-risk/#respond)	
VIRAL URI – DISCHARGE	
MDM	
This * patient presents with symptoms suspicious for likely viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]]. Differential includes [[Bacterial Pneumonia]], [[Sinusitis]], allergic rhinitis, *. Do not suspect underlying cardiopulmonary process. I considered, but think unlikely, dangerous causes of this patient’s symptoms to include ACS, [[CHF (Congestive v[[HF (Heart Failure)]])]] or [[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]]s, pneumonia, [[PTX (Pneumothorax)]]. Patient is nontoxic appearing and not in need of emergent medical intervention.	
Plan: reassurance, reassessment, over the counter medications, discharge with PCP followup	
November 28, 2018 Leave a comment	
VIRAL URI – DISCHARGE	
MDM	
This * patient presents with symptoms suspicious for likely viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]]. Differential includes [[Bacterial Pneumonia]], [[Sinusitis]], allergic rhinitis, *. Do not suspect underlying cardiopulmonary process. I considered, but think unlikely, dangerous causes of this patient’s symptoms to include ACS, [[CHF (Congestive v[[HF (Heart Failure)]])]] or [[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]]s, pneumonia, [[PTX (Pneumothorax)]]. Patient is nontoxic appearing and not in need of emergent medical intervention.	
Plan: reassurance, reassessment, over the counter medications, discharge with PCP followup	
November 28, 2018 Leave a comment	
HPI	
HPI5Ds	
No [[Dysphagia]], [[Dysarthria]], diplopia. No difficulty with gait or coordination.	
HPIAMS	
_ presents with [[AMS (Altered Mental Status)]].	
Patient’s history is notable for: _.	
Patient was brought in by _. Patient was found at _.	
Denies ingestion. _	
Patient without history of similar in past._	
Glucose in field was _.	
Denies seizure history. No seizure activity witnessed. Denies incontinence or [[Tongue]] biting._	
Denies falls or recent trauma._	
HPIAbdominalPain	
Patient presents with [[Abdominal Pain]].	
Patient’s history is notable for: _.	
Patient first noted the [[Abdominal Pain]] _. Pain is at diffuse/RUQ/LUQ/RLQ/[[LLQ (Left Lower Quadrant)]]/epigastric _. Discomfort is described as a pressure/sharp/dull_ sensation without/with _ radiation to groin/back. Patient has had this [[Abdominal Pain]] before_. Pain is nonexertional and not positional_.	
Pain is not associated with food_. Pain is alleviated by _ and worsened by _.	
Patient denies past abdominal surgeries. Last [[Bowel Movement]] was _. Endorses flatus._	
Denies nausea or vomiting. Able to tolerate PO without difficulty._	
Denies [[Diarrhea]], [[BRBPR (Hematochezia; Bright Red Blood Per Rectum)]], or [[Melena (Dark Tarry Stool)]]._	
Denies [[Dysuria]] or [[Hematuria]]. Denies flank pain. _	
Denies recent travel._	
Denies recent antibiotics or hospitalizations._	
HPIBackPain	
Patient has no history of malignancy, active or distant history. Patient is not less than 16 or greater than 50. Patient has no unexplained weight loss. No recent fevers, rigors, [[Malaise]], or recent infection. No history of [[IVDU; IVDA (IV (Intravenous) Drug Abuse)]] or skin-popping. Patient does not have any [[Saddle Anesthesia]]/[[Perianal]] sensory loss or complaining of [[↓ Rectal Tone]]. Patient does not have [[Urinary Retention]] or inability to control urine from overflow. Patient has no tenderness overlying spinous process. Patient has normal gait and able to walk on heels/ toes. Patient has no focal weakness on examination. Patient does not have hyperreflexia on examination.	
HPIChestPain	
Patient has a history significant for _.	
[[Chest Discomfort]] is described as a pressure/sharp/dull sensation without/with radiation to neck/arm/back. Patient has had this chest pain before. Chest pain is nonexertional. Chest pain started at _ and has been intermittent/constant/progressive/nonprogressive. Patient last chest pain was at _.	
Chest pain is non-pleuritic and not positional_. Chest pain is not associated with food.	
Patient endorses the following symptoms: _	
Patient denies any associated symptoms, including [[Near Syncope]], syncope, palpitations, [[SOB (Shortness of Breath)]], nausea, vomiting, [[Sweating]]._	
Denies [[Orthopnea ([[SOB (Shortness of Breath)]] (dyspnea) That Occurs When Lying Flat)]], PND, or LEE.	
Denies upper respiratory symptoms or productive cough.	
Patient denies any [[Lower Extremity Edema]], pain, asymmetry, or swelling.	
Denies prior [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]/PE or history of malignancy or known [[(Hypercoagulable; Prothrombotic) (State; Disorder; Condition) (Thrombophilia)]].	
Patient has had no decline in their exercise tolerance.	
Patient denies any tearing chest pain.	
Patient denies any early family history of cardiac death or MI.	
Patient has been compliant with home medications	
HPIPEDSRash	
fully vaccinated, otherwise healthy M_ who presents with rash for past day_. Rash started centripetally_ and is scattered papular mildly pruritic over chest and face_ with no oral involvement. Patient with mild URI symptoms several days prior and fever, now resolved. Patient otherwise at baseline with baseline mental status, activity level, UOP and PO intake intact. Denies sick contacts. Denies other family members with rash. Denies discharge, fevers, recent travel/hospitalizations/antibiotics.	
HPIPEDSURI	
vaccinations up to date_, full term, otherwise healthy boy_ who presents with upper respiratory symptoms including a non[[Productive Cough]], congestion and [[Coryza]] for 2-3_ days. Patient also with fever for 2 days_. Endorse sick contact_ in father with similar symptoms. Stable UOP. No nausea or vomiting. Normal PO intake. No rashes. At baseline mental status and activity level without [[Lethargy]]. No recent travel. No overt [[Abdominal Pain]], headache, ear pain, or [[SOB (Shortness of Breath)]]. No increase in respiratory effort.	
HPI	
[[Pre-Eclampsia]]	
Patient is asymptomatic currently and at baseline_. Patient was seen in clinic today by primary OB and patient had two mildly [[↑↑↑ [[BP (Blood P (Pressure))]] ↑↑↑]] readings_. Patient denies known personal and family history of [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]]_. Denies headache or vision changes, including [[Photophobia]], [[Blurred Vision]], and [[Scotoma(ta); [[Visual Field(s)]] (Defect; Deficit)]]. Denies [[Abdominal Pain]], nausea, vomiting, focal weakness or parasthesias. Endorses persistent, although stable, intermittent [[Lower Extremity Edema]] without further asymmetry or pain. Denies chest pain or [[SOB (Shortness of Breath)]]. Denies PND or DOE. Denies oozing with brushing teeth or new easy bruising. Denies [[Vaginal Bleeding]], loss of fluid, [[Contractions]]. Endorses stable and active movement of fetus.	
HPIPsych	
_who presents with SI_.	
Patient’s history is notable for: _. Patient was brought in voluntarily/by family/by police_. A temporary hold was/was not placed prior to arrival. _	
Patient was in normal state of health until approximately _ days ago. At this time, patient noted _. Patient came in today due to _.	
Patient endorses SI with plan to _.	
Denies previous suicide attempt. Patient has been compliant with his medications._	
Patient denies any ingestions including tylenol or aspirin._	
Denies [[Illicit (Substance; Drug) (Use)]] including [[IVDU; IVDA (IV (Intravenous) Drug Abuse)]], [[Amphetamines]], [[Marijuana (Cannabis)]], or alcohol. _	
Patient is seen by Dr. _.	
Denies previous hospitalizations._	
Denies [[Hallucinations]], auditory or visual._	
Denies HI/HA._	
Patient is able to perform daily functions and contracts to safety._	
HPISOB	
presents with [[SOB (Shortness of Breath)]]. Patient’s history is significant for _.	
Patient first noticed increased shortness of breath _. [[SOB (Shortness of Breath)]] has been progressive_. Denies alleviating or exacerbating factors_. Denies similar episodes in past. Denies changes in position. Denies pleurisy.	
Denies chest pain, [[Abdominal Pain]], nausea or vomiting. Denies fevers._	
Denies home oxygen requirement or increase in oxygen requirement._	
Denies recent travel. Denies sick contacts_.	
Denies upper respiratory symptoms, including [[Productive Cough]], [[Hematemesis]], [[Sore Throat (Pharyngitis)]] or runny nose._	
Denies [[Lower Extremity Edema]], swelling, asymmetry or pain._	
Denies history of [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]/PE. Denies known malignancy or [[(Hypercoagulable; Prothrombotic) (State; Disorder; Condition) (Thrombophilia)]].	
Denies smoking or OCP use.	
Patient has been compliant with home medications.	
HPIURI	
otherwise healthy p/w four_ days of productive cough without [[Hemoptysis]], mild chills now resolved, no overt fever, also associated with concurrent [[Coryza]] and congestion_. Denies chest pain or [[SOB (Shortness of Breath)]]. Denies LE edema, asymmetry or pain. Denies AP, n/v. Denies headache, fevers or chills. Denies [[Orthopnea (Shortness of Breath (dyspnea) That Occurs When Lying Flat)]] or PND. + sick contact also with similar [[Constellation]] of symptoms. No travel.	
SCORE	
.HEARTSCORE	
http://www.mdcalc.com/heart-score-for-major-cardiac-events/	
Upon calculating the patient’s HEART score, they were found to have a score of 0-3, which indicates low risk, so the patient can be safely discharged with the understanding that they need to make an appointment with a primary care doctor to be referred for a stress test within the next 48-72 hours, or if they cannot arrange that they are to return to the ED, or sooner than that if they have any changing, persistent, or worsening symptoms.	
In the studies referenced below, the patients in the low risk group were discharged and found to have a 0.9-1.7% change of having a major adverse cardiac event (defined as revascularization, myocardial [[Infarction]], or all-cause mortality) within 6 weeks when studied both retrospectively and prospectively.	
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008 Jun;16(6):191-6. PMID: 18665203	
Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. PMID: 23465250.	
Resources	
.HEARTSCORE	
http://www.mdcalc.com/heart-score-for-major-cardiac-events/	
Upon calculating the patient’s HEART score, they were found to have a score of 0-3, which indicates low risk, so the patient can be safely discharged with the understanding that they need to make an appointment with a primary care doctor to be referred for a stress test within the next 48-72 hours, or if they cannot arrange that they are to return to the ED, or sooner than that if they have any changing, persistent, or worsening symptoms.	
In the studies referenced below, the patients in the low risk group were discharged and found to have a 0.9-1.7% change of having a major adverse cardiac event (defined as revascularization, myocardial [[Infarction]], or all-cause mortality) within 6 weeks when studied both retrospectively and prospectively.	
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008 Jun;16(6):191-6. PMID: 18665203	
Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. PMID: 23465250.	
Resources	
.NIHSSMOD	
NIH Stroke Scale:	
Interval: {NIHSS interval:17994}	
Time: {Time; 0100-2400:14903} ***	
Person Administering Scale: ***	
1a. Level of consciousness: {exam; consciousness neuro:31423}	
1b. LOC questions: (month; age) * 0 – answers both questions correctly * 1 – one question correctly *** 2 – neither question correctly	
1c. LOC commands: [open/close eyes; grip/ release hand or other 1-step command] {Loc commands neuro:31401}	
2. Best Gaze: [test horizontal only. Isolated peripheral [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]],4,6 palsy =1] {exam; best gaze neuro:31402}	
3. Visual: [upper & lower VF quadrants] {Visual neuro:31403}	
4. [[Facial Palsy]]: [show teeth, raise eyebrows, close eyes] {Exam; neuro facial palsy:31404}	
5a. Motor left arm: [extend arms] {Motor arm:27865}	
5b. Motor right arm: {Motor arm:27865}	
6a. Motor left leg: [hold 30 degrees supine] {Motor leg:27866}	
6b. Motor right leg: [hold 30 degrees supine] {Motor leg:27866}	
7. Limb Ataxia: [w/ eyes open. (B) Finger to nose; (B) heel to shin. ‘0’ if paralyzed or does not understand] {Limb ataxia neuro:31406}	
8. Sensory: [to pinprick. If coma-> 2] {SENSORY:18028}	
9. Best Language: [describe picture; name items in picture; read sentences] {exam; best language neuro:31408}	
10. [[Dysarthria]]:[read or repeat words] {[[Dysarthria]] neuro:31409}	
11. Extinction and Inattention: {findings; extinction neuro:31410}	
Total: {0-42:17997}	
Note:	
A patient with a completely normal neurological exam and normal mental status	
will have an NIHSS of 0. The maximum recordable [[NIHSS Score]] is 42. However,	
since acute [[Ischemic Stroke]] causes unilateral paralysis and [[Blindness]], the maximum	
score actually is 31 for a stroke patient with complete hemiparesis, [[Hemianopia]],	
hemineglect, and aphasia.	
Patients with an [[NIHSS Score]] greater than 15-20 are considered to have a severe	
stroke clinically.	
.NIHSSMOD	
NIH Stroke Scale:	
Interval: {NIHSS interval:17994}	
Time: {Time; 0100-2400:14903} ***	
Person Administering Scale: ***	
1a. Level of consciousness: {exam; consciousness neuro:31423}	
1b. LOC questions: (month; age) * 0 – answers both questions correctly * 1 – one question correctly *** 2 – neither question correctly	
1c. LOC commands: [open/close eyes; grip/ release hand or other 1-step command] {Loc commands neuro:31401}	
2. Best Gaze: [test horizontal only. Isolated peripheral [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]],4,6 palsy =1] {exam; best gaze neuro:31402}	
3. Visual: [upper & lower VF quadrants] {Visual neuro:31403}	
4. [[Facial Palsy]]: [show teeth, raise eyebrows, close eyes] {Exam; neuro facial palsy:31404}	
5a. Motor left arm: [extend arms] {Motor arm:27865}	
5b. Motor right arm: {Motor arm:27865}	
6a. Motor left leg: [hold 30 degrees supine] {Motor leg:27866}	
6b. Motor right leg: [hold 30 degrees supine] {Motor leg:27866}	
7. Limb Ataxia: [w/ eyes open. (B) Finger to nose; (B) heel to shin. ‘0’ if paralyzed or does not understand] {Limb ataxia neuro:31406}	
8. Sensory: [to pinprick. If coma-> 2] {SENSORY:18028}	
9. Best Language: [describe picture; name items in picture; read sentences] {exam; best language neuro:31408}	
10. [[Dysarthria]]:[read or repeat words] {[[Dysarthria]] neuro:31409}	
11. Extinction and Inattention: {findings; extinction neuro:31410}	
Total: {0-42:17997}	
Note:	
A patient with a completely normal neurological exam and normal mental status	
will have an NIHSS of 0. The maximum recordable [[NIHSS Score]] is 42. However,	
since acute [[Ischemic Stroke]] causes unilateral paralysis and [[Blindness]], the maximum	
score actually is 31 for a stroke patient with complete hemiparesis, [[Hemianopia]],	
hemineglect, and aphasia.	
Patients with an [[NIHSS Score]] greater than 15-20 are considered to have a severe	
stroke clinically.	
.TPACONTRAINDICATIONS	
[[Exclusion Criteria]]	
— Significant head trauma or prior stroke in previous 3 months	
— Symptoms suggest [[SAH (Subarachnoid Hemorrhage)]]	
— History of previous [[ICH (Intracranial Hemorrhage)]]	
— Intracranial neoplasm, [[AVM (Arteriovenous Malformation)]], or [[Aneurysm]]	
— Recent intracranial or intraspinal surgery	
— [[Arterial Puncture]] at noncompressible site in previous 7 days	
— Elevated blood pressure (systolic >185 mm Hg or diastolic >110 mm Hg)	
— Active internal bleeding	
— Blood glucose concentration <50mg/dl (2.7mmol/L)	
— Acute bleeding diathesis, including but not limited to: Platelet count <100 000/mm³ (In patients without history of [[Thrombocytopenia]],	
treatment with IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm³.)	
— [[Heparin]] received within 48 hours, resulting in abnormally elevated [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]] greater than the upper limit of normal	
— Current use of anticoagulant with INR >1.7 or PT >15 seconds (In patients without recent use of oral [[Anti(-)Coagulant(s)]] or [[Heparin]], treatment with	
IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT	
is abnormally elevated by local laboratory standards.)	
— Current use of [[DTI (Direct Thrombin Inhibitor)]]s or direct [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] inhibitors with elevated sensitive laboratory tests (such as [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]], INR, platelet	
count, and ECT; TT; or appropriate [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] activity assays)	
— CT demonstrates multilobar [[Infarction]] (hypodensity >1/3 cerebral hemisphere)	
Relative [[Exclusion Criteria]]	
Recent experience suggests that under some circumstances—with careful consideration and weighting of risk to benefit—patients may receive	
fibrinolytic therapy despite 1 or more relative contraindications. Consider risk to benefit of IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] administration carefully if any of these relative	
contraindications are present:	
— Only minor or rapidly improving stroke symptoms (clearing spontaneously)	
— Seizure at onset with postictal residual neurological impairments	
— Major surgery or serious trauma within previous 14 days	
— Recent gastrointestinal or urinary tract [[Hemorrhage]] (within previous 21 days)	
— Pregnancy	
.TPACONTRAINDICATIONS	
[[Exclusion Criteria]]	
— Significant head trauma or prior stroke in previous 3 months	
— Symptoms suggest [[SAH (Subarachnoid Hemorrhage)]]	
— History of previous [[ICH (Intracranial Hemorrhage)]]	
— Intracranial neoplasm, [[AVM (Arteriovenous Malformation)]], or [[Aneurysm]]	
— Recent intracranial or intraspinal surgery	
— [[Arterial Puncture]] at noncompressible site in previous 7 days	
— Elevated blood pressure (systolic >185 mm Hg or diastolic >110 mm Hg)	
— Active internal bleeding	
— Blood glucose concentration <50mg/dl (2.7mmol/L)	
— Acute bleeding diathesis, including but not limited to: Platelet count <100 000/mm³ (In patients without history of [[Thrombocytopenia]],	
treatment with IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm³.)	
— [[Heparin]] received within 48 hours, resulting in abnormally elevated [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]] greater than the upper limit of normal	
— Current use of anticoagulant with INR >1.7 or PT >15 seconds (In patients without recent use of oral [[Anti(-)Coagulant(s)]] or [[Heparin]], treatment with	
IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT	
is abnormally elevated by local laboratory standards.)	
— Current use of [[DTI (Direct Thrombin Inhibitor)]]s or direct [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] inhibitors with elevated sensitive laboratory tests (such as [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]], INR, platelet	
count, and ECT; TT; or appropriate [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] activity assays)	
— CT demonstrates multilobar [[Infarction]] (hypodensity >1/3 cerebral hemisphere)	
Relative [[Exclusion Criteria]]	
Recent experience suggests that under some circumstances—with careful consideration and weighting of risk to benefit—patients may receive	
fibrinolytic therapy despite 1 or more relative contraindications. Consider risk to benefit of IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] administration carefully if any of these relative	
contraindications are present:	
— Only minor or rapidly improving stroke symptoms (clearing spontaneously)	
— Seizure at onset with postictal residual neurological impairments	
— Major surgery or serious trauma within previous 14 days	
— Recent gastrointestinal or urinary tract [[Hemorrhage]] (within previous 21 days)	
— Pregnancy	
CDC Recommendations (2013)	
* Kuhar DT, Henderson DK, Struble KA, et al. Updated U.S. Public Health Service guidelines for the management of [[Occupational Exposure]]s to [[HIV (Human Immunodeficiency Virus)]] and recommendations for postexposure [[Prophylaxis]]. Infect Control Hosp Epidemiol 2013;34: 875-892. Available at: http://stacks.cdc.gov/view/cdc/20711	
Indications: Percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or potentially infectious body fluids, such as semen, vaginal secretions, and visibly [[Bloody Fluid]]s and reasonable suspicion that the source patient is HIV-infected.	
Source Testing:	
Although concerns have been expressed regarding HIV-negative sources being in the window period for seroconversion, no case of transmission involving an exposure source during the window period has been reported in the United States. Rapid HIV testing of source patients can facilitate making timely decisions regarding use of HIV PEP after occupational exposures to sources of unknown HIV status.	
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Raltegravir 400 mg PO twice daily	
Duration of PEP: 4 weeks	
HIV Antibody Testing of Healthcare Worker	
Baseline	
6 weeks post-exposure	
12 weeks post-exposure	
6 months post-exposure	
Alternatively, if the clinician is certain that a fourth-generation antibody/antigen combination assay is being used, then HIV testing could be performed at baseline, 6 weeks, and concluded at 4 months post-exposure.	
PEP should be initiated as soon as possible, preferably within hours rather than days of exposure. Initiation of PEP should not be delayed while awaiting the results of a source patient’s HIV test, nor should it be delayed during consultation with experts to determine ideal PEP regimens.	
Rationale:	
Several clinical studies have demonstrated that HIV transmission can be significantly reduced by the post-exposure administration of [[Anti-Retroviral Therapy]] agents. A dramatic decline in vertical transmission was observed in the AIDS Clinical Trial Group (ACTG) 076 study,1 in which pregnant women and their newborns received monotherapy with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] ([[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]), and in the HIVNET 012 study,2 in which single-dose [[NVP (Nevirapine, VIRAMUNE)]] was compared with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]. A CDC retrospective [[Case Control]] study3 of [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] use after occupational HIV exposure in healthcare workers (HCWs) showed an 81% reduction in risk of [[HIV (Human Immunodeficiency Virus)]] in persons who received [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]].	
Because the ultimate goals of PEP are to maximally suppress any limited viral replication that may occur and to shift the biologic advantage to the host cellular immune system to prevent or abort early infection, the Committee recommends the use of a three-drug PEP regimen for all significant risk exposures.	
Relative Risks:	
Estimated Per-Act Probability of Acquiring HIV From a Known HIV-Infected Source by Exposure Act	
Type of Exposure Risk per 10,000 Exposures	
Parenteral	
Blood Transfusion 9,000	
Percutaneous ([[Needle Stick]]) 30	
Sexual	
Receptive anal intercourse 138	
Insertive anal intercourse 11	
Receptive penile-vaginal intercourse 8	
Insertive penile-vaginal intercourse 4	
Receptive oral intercourse low	
Insertive oral intercourse low	
Other	
Biting Negligible	
Spitting Negligible	
Throwing body fluids Negligible	
(including semen or saliva)	
http://www.cdc.gov/hiv/law/transmission.htm.	
Factors that increase the risk of HIV transmission include early and late-stage [[HIV (Human Immunodeficiency Virus)]] and a high level of HIV in the blood. Factors that reduce the risk of HIV transmission include low level of HIV in the blood and the use of ART.	
NYSDOH AI Recommendations (2014)	
Indication: Percutaneous or [[Mucocutaneous]] exposure with blood or visibly [[Bloody Fluid]] or other potentially infectious material.	
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily or [[Lamivudine (EPIVIR)]] 300 mg PO daily plus Either Raltegravir 400 mg PO twice daily or [[Dolutegravir (DOVATO)]] 50 mg PO daily	
HIV Antibody Testing of Healthcare Worker	
Baseline	
4 weeks post-exposure	
12 weeks post-exposure	
When a potential [[Occupational Exposure]] to HIV occurs, every effort should be made to initiate PEP, as soon as possible, ideally within 2 hours. A first dose of PEP should be offered to the exposed worker while the evaluation is underway. In addition, PEP should not be delayed while awaiting information about the source or results of the exposed individual’s baseline HIV test.	
Decisions regarding initiation of PEP beyond 36 hours post exposure should be made on a case-by-case basis with the understanding of diminished efficacy when timing of initiation is prolonged.	
PROG	
PROGAlcohol	
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient with increased lucidity, tolerating PO, interactive with staff. [[Hemodynamic(ally) (Stability, Stable)]].	
Trialed gait after several hours of observation in the ED with improvement in mental status to baseline and with stable gait. Cautious return precautions discussed w/ full understanding.	
PROGAMA	
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.	
PROGAnkle	
X-ray does not reveal any fractures, likely ankle sprain. Discussed discharge instructions with parents and return precautions. Parents expressed verbal understanding and agreement with care plan. All questions answered. Given crutches and an ankle brace. Patient is well-appearing, in no apparent distress, and vital signs stable for discharge home.	
PROG[[Asthma]]	
Patient reassessed and respiratory status has stabilized while in the department and appears appropriate for outpatient work up. Exam and work up not consistent w/ impending [[Respiratory Failure]] or cardiovascular collapse. Afebrile with low suspicion for acute pneumonia. Patient not hypoxic, fully ambulatory without [[Respiratory Distress]]. Medications refilled and strict return precautions discussed.	
PROGECG	
EKG reviewed, no overt evidence of contiguous ST segment elevations, low suspicion for acute MI. No overt tachy- or brady[[Dysrhythmia]]s. Low suspicion for [[WPW (Congenital Pre-Excitation Syndrome; Wolff-Parkinson-White)]], [[QT Interval (Segment) Prolongation]], [[HOCM (Hypertrophic Obstructive Cardiomyopathy)]], [[Brugada Syndrome]] after EKG review.	
PROGLacRepair	
As above, patient with unchanged neurovascular exam post procedure. No [[Foreign Body]] sensation after repair but discussed possible smaller fragments being retained despite close inspection under bright field and copious irrigation with saline_. Cautious return precautions discussed w/ full understanding.	
PROGHeadCTMDM	
After extensive discussion with family regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time_. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Patient with nonfocal neurologic exam and with low suspicion for overt [[ICH (Intracranial Hemorrhage)]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.	
PROGHeadTraumaPeds	
Serial neuro exam without new focal neuro signs or [[AMS (Altered Mental Status)]], has been at baseline mental status; seen running and walking around ER smiling and playful. No emesis. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]]. Discussed case at length with parents and requesting to go home. Given reliability of parents (both father, mother, and grandmother at bedside with appropriate concern and interaction), low suspicion for NAT and seems reliable to monitor and bring back patient if any changes or concerns. Mutual decision to discharge home with strict return precautions.	
PROGReexaminationAP	
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]].	
PROGCapacity	
This was assessed during the medical interview. Capacity to make one’s own medical decisions is based upon a patient’s ability to understand the decision that is being made, the possible options, the risks and benefits of those options, demonstrate understanding of this information and the ability to apply it to themselves, and ultimately the ability to communicate a decision. Capacity is dynamic over time, and the threshold for capacity is different dependent on the specific decision and its risks and benefits. Given our conversation, the patient at this time does appear to have the ability to communicate a preference to leave the hospital rather than stay and have medical workup_. The patient does understand the benefits of their decision, which include personal [[Autonomy]] and the ability to seek care elsewhere, as well as the risks, which include delay in medical workup and possible worsening of symptoms. Given their ability to reason through this decision, and the risk of leaving the hospital _, the patient does appear to have capacity at this time_. Therefore, we will respect the patient’s [[Autonomy]] to make their own decisions, which at this time is expressed as a desire for discharge.	
Of note, at this time, it the patient does not seem to meet criteria for an in[[Voluntary]] hold based on grave disability. Patient is able to state a clear and viable plan for obtaining her own food, clothing, and shelter._	
PROG[[CRP (C-Reactive Protein)]]	
Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
PROGPEDSHeadTraumaReassess	
Serial neuro exam without new focal neuro signs or AMS, has been at baseline mental status; seen running and walking around ER smiling and playful. No emesis. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]]. Discussed case at length with parents and requesting to go home. Given reliability of parents (both father, mother, and grandmother at bedside with appropriate concern and interaction), low suspicion for NAT and seems reliable to monitor and bring back patient if any changes or concerns. Mutual decision to discharge home with strict return precautions.	
PROGSignOut	
ED Sign Out	
The patient’s care was signed out to Dr. * at 20:00*.	
Items Pending at sign out: ***	
Impression at the time of sign out: ***	
Expected disposition: ***	
(I spoke to the physician taking over care about the plan for this patient, but the final disposition will depend on the results of the patient’s studies/labs and condition upon re-evaluation. The original plan may alter depending on the patient’s medical needs.)	
Discharge Instructions	
MDM	
MDM – AKI/DEHYDRATION	
MDM	
Mild, Discharge:	
This patient presents with generalized weakness and fatigue likely secondary to dehydration.	
Suspect [[AKI, ARF (Acute (Renal Failure; Kidney Injury))]] of prerenal origin.	
Doubt intrinsic [[Renal Dysfunction]] or obstructive nephropathy.	
Considered alternate etiologies of the patient’s symptoms including infectious processes, severe metabolic derangements or [[Electrolyte Abnormality]], [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]/ACS, [[HF (Heart Failure)]], and intracranial/central processes but think these are unlikely given the history and [[PE (Physical Exam(ination))]].	
Plan: labs, ***fluid resuscitation, pain/nausea control, reassessment	
MDM – [[Asthma]], MILD (PEDS)	
MDM, Peds	
Differential Diagnosis: Cough, [[Wheez(-e -es; -ing)]], [[Asthma Exacerbation]], pneumonia, seasonal allergies, viral syndrome, [[PTX (Pneumothorax)]].	
Rationale: Given the history of cough, difficulty breathing, [[Wheez(-e -es; -ing)]] and history of [[Asthma]], the patient’s symptoms may be attributed to either viral syndrome, pneumonia, acute [[Asthma Exacerbation]] or [[PTX (Pneumothorax)]]. Most likely, this represents an acute [[Asthma Exacerbation]].	
1) STAT bronchodilator therapy and [[Steroid]] will be given, with re-assessments between nebulized treatments.	
2) If worsening or persistent symptoms occur, the patient may require critical care management or admission to the hospital.	
MDM – BICEPS TENDON PROBLEM	
MDM, [[PE (Physical Exam(ination))]]	
This _ presents with upper arm pain and exam findings suspicious for a [[Biceps Tendon Rupture]]. Differential includes [[Bursitis]], muscle strain, partial tear, fracture, and elbow pathology. Neurovascularly intact distal to the injury.	
Plan: plain films, urgent orthopedic referral, [[Pain Control]], reassessment, anticipating discharge	
PEARLS:	
– Classic mechanism for [[Biceps Tendon Rupture]]:	
— FOOSH – proximal rupture	
— Elbow forced straight against resistance – distal	
– Exam: “[[Popeye Sign]]” from rupturing of the long head of the biceps. Probably will be able to still flex a little if it’s proximal.	
– If they have a distal rupture, they will have marked ecchymosis over the AC and marked weakness on flexion	
– Hook test: you should be able to get about 1 cm under the biceps tendon with your finger as a ‘hook’	
Proximal ruptures are usually managed nonop; distal ruptures require near-term urgent ortho f/u.	
January 8, 2019 Tagged msk, ortho Leave a comment	
MDM – BICEPS TENDON PROBLEM	
MDM, [[PE (Physical Exam(ination))]]](https://natedotphrase.com/tag/physical-exam/)	
This _ presents with upper arm pain and exam findings suspicious for a [[Biceps Tendon Rupture]]. Differential includes [[Bursitis]], muscle strain, partial tear, fracture, and elbow pathology. Neurovascularly intact distal to the injury.	
Plan: plain films, urgent orthopedic referral, [[Pain Control]], reassessment, anticipating discharge	
PEARLS:	
– Classic mechanism for [[Biceps Tendon Rupture]]:	
— FOOSH – proximal rupture	
— Elbow forced straight against resistance – distal	
– Exam: “[[Popeye Sign]]” from rupturing of the long head of the biceps. Probably will be able to still flex a little if it’s proximal.	
– If they have a distal rupture, they will have marked ecchymosis over the AC and marked weakness on flexion	
– Hook test: you should be able to get about 1 cm under the biceps tendon with your finger as a ‘hook’	
Proximal ruptures are usually managed nonop; distal ruptures require near-term urgent ortho f/u.	
January 8, 2019 Tagged msk, ortho Leave a comment	
MDM – CELLULITIS	
Uncategorized	
presents with initial presentation of local erythema, warmth, swelling to  for ___ days.	
Sensitivity/pain to [[Light Touch]] around the erythematous area.	
No lymphangitic spread visible and no fluid pockets or fluctuance c/f abscess noted.	
Low c/f [[Osteomyelitis]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].	
No immune compromise, [[Bullae]], pain [[Out of proportion]], or rapid progression c/f [[NF (Necrotizing Fasciitis)]].	
In ED: Erythema outlined	
Rx: [[Cephalexin (KEFLEX)]] 500mg PO q6hrs	
Disposition: No evidence of serious bacterial illness requiring admission for [[[[IV (Intravenous)]] Antibiotics]]. Nontoxic appearing, VSS. Low risk for treatment failure based on history. Will discharge home with PO antibiotics and return precautions discussed at bedside.	
MDM – CELLULITIS (DC)	
Uncategorized	
This patient presents with initial presentation of local erythema, warmth, swelling concerning for cellulitis.	
Sensitivity/pain to [[Light Touch]] around the erythematous area.	
No lymphangitic spread visible and no fluid pockets or fluctuance c/f abscess noted.	
Low c/f [[Osteomyelitis]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].	
No immune compromise, [[Bullae]], pain out of proportion, or rapid progression c/f [[NF (Necrotizing Fasciitis)]].	
In ED: Erythema outlined	
Rx: [[Cephalexin (KEFLEX)]] 500mg PO q6hrs,_	
Disposition: No evidence of serious bacterial illness requiring admission for [[[[IV (Intravenous)]] Antibiotics]]. Nontoxic appearing, VSS. Low risk for treatment failure based on history. Will discharge home with PO antibiotics and return precautions discussed at bedside.	
January 23, 2019 Leave a comment	
MDM – CELLULITIS (DC)	
Uncategorized	
This patient presents with initial presentation of local erythema, warmth, swelling concerning for cellulitis.	
Sensitivity/pain to [[Light Touch]] around the erythematous area.	
No lymphangitic spread visible and no fluid pockets or fluctuance c/f abscess noted.	
Low c/f [[Osteomyelitis]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].	
No immune compromise, [[Bullae]], pain [[Out of proportion]], or rapid progression c/f [[NF (Necrotizing Fasciitis)]].	
In ED: Erythema outlined	
Rx: [[Cephalexin (KEFLEX)]] 500mg PO q6hrs,_	
Disposition: No evidence of serious bacterial illness requiring admission for [[[[IV (Intravenous)]] Antibiotics]]. Nontoxic appearing, VSS. Low risk for treatment failure based on history. Will discharge home with PO antibiotics and return precautions discussed at bedside.	
January 23, 2019 Leave a comment	
MDM – [[Diarrhea]] (LOW RISK)	
MDM, Uncategorized	
This patient presents with [[Diarrhea]] consistent with likely viral enteritis.	
Doubt acute [[Bacterial [[Diarrhea]]]].	
Considered, but think unlikely, partial SBO, [[Appendicitis]], [[Diverticulitis]], other intraabdominal infection.	
Low suspicion for secondary causes of [[Diarrhea]] such as hyperadrenergic state, pheo, [[Hypoadrenalism ((Acute; Severe) (Adrenal Insufficiency; ((Addisonian; Adrenal) Crisis))]], [[Hyperthyroidism]], or sepsis.	
Doubt antibiotic associated [[Diarrhea]].	
Plan: PO rehydration, reassess, discharge with OTC anti[[Diarrhea]]l meds//short course antibiotics	
MDM – [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]] DISCHARGE	
MDM	
This _ presents with leg swelling of unclear etiology, concerning for [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]] vs cellulitis. DDX includes chronic venous stasis changes, lymphedema, fracture or trauma, MSK pain, and other nonemergent causes of leg swelling. Doubt atypical presentation of [[CHF (Congestive v[[HF (Heart Failure)]])]] or other [[Volume Overload]] states. PE is low on the differential due to normal vital signs without symptoms. Low suspicion for constitutional infection or metabolic derangements.	
Plan: basic labs, [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]] US, consider plain films, reassess, likely discharge	
MDM – HEAD TRAUMA, NOT SICK	
MDM	
This _ presents with head trauma after a mechanical GLF. DDX includes MSK trauma, facial fractures, ICH or traumatic SAH, C-spine injury. Doubt other extracranial causes of injury. Considered nonmechanical causes of fall such as syncope, primary cardiopulmonary etiologies such as ACS/PE, but think these are unlikely. Will get head/face/neck CT, [[Pain Control]], C-collar, basic labs, reassess, discharge	
MDM – KNEE PAIN (+)	
MDM	
LOW RISK	
This * patient presents with knee pain, suspicious for *. Able to flex and extend although somewhat limited by pain. Considered, but doubt, tibial plateau fracture, [[Septic Arthritis]], other acute unstable fracture, or significant neuro[[Vascular Compromise]].	
Plan: XR, [[Pain Control]], reassessment	
HI RISK – Tibial Plateau	
This * patient presents with knee pain suspicious for a tibial plateau fracture given history, exam, and mechanism. No e/o [[Compartment Syndrome]], [[Septic Arthritis]], other acute fracture. Range of motion is *. Will get plain films, consider CT, likely ortho consultation, [[Pain Control]], NWB.	
PEARLS:	
Knee EXTENSION is an extremely important motor finding to document. Inability to extend is a key indicator of serious pathology.	
In peds, follow the medial tibial diaphysis up to the [[Epiphysis]] – it should be smooth all the way. A bump should make you suspicious for a buckle fracture; it’s frequently missed by radiology.	
Proximal fibular fractures are associated with a peroneal nerve injury (you should document its status)	
Tibial plateau fractures are high risk for [[Compartment Syndrome]].	
Tibial spine fractures are a) associated with ACL tears and b) often missed unless you order a tunnel view plain film.	
MDM – MISCELLANEOUS	
Uncategorized	
AMA Documentation	
Capacity Assessment	
Homelessness Documentation	
[COVID FAQ – Discharge Instructions](https://natedotphrase.wordpress.com/2020/03/13/[[COVID; COVID-19; SARS CoV 2 (Corona Virus 19; Severe Acute Respiratory Syndrome Coronavirus 2)]]-dc-instructions-and-faq/)	
April 18, 2018 Leave a comment	
MDM – MISCELLANEOUS	
Uncategorized	
AMA Documentation	
Capacity Assessment	
Homelessness Documentation	
COVID FAQ – Discharge Instructions	
MDM – [[HHV-3; VZV ((Human) (Herpes) (Varicella) (Zoster) Virus (3); Shingles; Chicken Pox)]]	
_ patient with a vesicular rash on an erythematous base in a dermatomal pattern consistent with [[HHV-3; VZV ((Human) (Herpes) (Varicella) (Zoster) Virus (3); Shingles; Chicken Pox)]]. Not immunocompromised and without signs of systemic or disseminated infection. Low suspicion for alternate etiology of rash such as SJS, drug rash, viral exanthem, or other emergent cause of rash.	
Plan: [[Acyclovir (ACV, ZOVIRAX)]] 800mg 5x/day for a week, [[Gabapentin (NEURONTIN)]] and other [[Pain Control]], reassessment, likely discharge	
MDM – SICK NEONATE (PEDS)	
MDM, Peds	
This is an ill-appearing *** who presents with [[Lethargy]].	
Differential includes sepsis, [[CHD (Congenital Heart Disease (Anomaly; Disorder; Defect; Condition; Lesion; Malformation))]], [[↓ ↓ ↓ Volume (depletion), (Hypovolemia) ↓ ↓ ↓]] and [[PO2 <8 kPa (Hypox(a)emia)]] states, endocrine emergencies like CAH or [[Thyroiditis]], trauma, inborn errors of [[Metabolism]], [[Seizure]], electrolyte derangements, or intestinal catastrophe.	
Given this undifferentiated sick neonate, will work up broadly, empiric [[Broad Spectrum Antibiotics]]***, trial of 10cc/kg fluid bolus, resuscitative measures and will consider early airway intervention.	
Pearls: For a sick kid use THE MISFITS:	
Trauma: consider FAST and CTH	
– consider [[Vitamin K (Phytonadione)]] and Ca if bleeding	
Heart disease, hypovolemia, hypoxia	
Endocrine (CAH, [[Graves Disease (Thyrotoxicosis)]])	
Metabolic – lytes	
Inborn errors	
Seizures	
Formula mishaps	
Intestinal catastrophes (volvulus, intuss, NEC)	
Toxins	
Sepsis	
MDM – [[Sickle Cell]] PAIN CRISIS, [[Acute Chest Syndrome]], STROKE	
TYPICAL [[Vaso-Occlusive Crisis]]	
This patient with known [[SCD (Sickle Cell Disease)]] presents with their classic pain syndrome for a [[Vaso-Occlusive Crisis]].	
Considered [[Acute Chest Syndrome]], stroke, [[Splenic Sequestration]], and other emergent complications of [[SCD (Sickle Cell Disease)]].	
Considered alternate etiologies of this patient’s pain to include fracture, MSK pain, infection/abscess, and other ischemic etiologies but doubt these are likely.	
Will plan for [[Pain Control]] using patient’s [[Pain Management]] plan, basic labs/[[Reticulocyte Count]], likely discharge	
[[Acute Chest Syndrome]]	
This patient with known SCD presents with chest/[[Back Pain (Dolor)]] consistent with [[Vaso-Occlusive Crisis]] but concerning for [[Acute Chest Syndrome]]; this presentation is different than the patient’s typical pain crisis. Considered alternate etiologies of chest pain including [[ACS (Acute Coronary Syndrome)]]s, PE, [[PTX (Pneumothorax)]] or pneumonia but think this is less likely.	
Plan: labs, [[Pain Control]], fluids, low threshold to transfuse to Hb>9, CXR, discuss with [[Hematology]], likely admit	
[[Splenic Sequestration]] OR STROKE	
This patient with [[SCD (Sickle Cell Disease)]] presents with [[AMS (Altered Mental Status)]], highly concerning for severe range anemia or stroke.	
[[Splenic Sequestration]] is also on the differential, although given this patient’s age it is quite unlikely that they still have functioning splenic tissue.	
I considered, but think less likely, other etiologies of [[AMS (Altered Mental Status)]] such as infection, metabolic derangements, or ICH.	
This symptom [[Constellation]] is concerning given the underlying medical comorbidities.	
Plan: basic labs, [[Reticulocyte Count]], consider hemolysis labs, XR chest, neuroimaging, probable stroke code activation, neuro and [[Hematology]] consults, admit	
MDM – TOE PAIN (INJURY)	
MDM	
This patient presents after a soft tissue injury to the toe. Considered, but doubt, acute fracture including open fracture. Low index of suspicion for a dislocation or Lisfranc injury. Doubt other acute causes of toe pain at this time.	
Plan: plain films, [[Pain Control]], reassess, likely discharge with podiatry/orthopedics followup, WBAT***	
MDM – TORSION/PELVIC PAIN	
MDM	
This female patient presents with lateralized pelvic pain, concerning for torsion. DDX includes TOA, PID, and other infectious symptoms but patient has no constitutional symptoms of infection.	
Ectopic is on the differential but unlikely.	
Also includes UTI, pyelo, [[Endometriosis]], adenomyosis but these are less likely.	
Doubt [[Appendicitis]] or other primary gastrointestinal process.	
Plan: labs, upreg, pelvic US, consder CT scan, pain and nausea control, fluid resuscitation, reassess	
MDM – TRANSPLANT REJECTION	
MDM	
This * patient with a history of transplant, on immunosuppression, presents with * concerning for acute rejection vs infection. Differential diagnosis includes ***. I considered, but think unlikely, emergent causes of these symptoms in an immunosuppressed patient, including [[Opportunistic Infection]]s, donor-related infections such as CMV, but think these are unlikely.	
Plan: basic labs, hold immunosuppression, gentle fluid resuscitation, discuss with transplant team, low threshold for [[Empiric Antibiotics]] and/or pulse dose [[Steroid]].	
Pearls:	
Most immunosuppression regimens include [[Steroid]] (out to about 6 months, but can be longer depending on the organ), [[[[CaN (Calcineurin)]] Inhibitor]] ([[Cyclosporin]], tacro), and an anti[[Proliferative]] med (MMF, AZA).	
[[Post Transplantation]] lympho[[Proliferative]] disorder: your meds knock down your T cell lines so much that your other cell lines escape their checkpoints. Can be mild (a few extra monos) to severe [[Lymphoma]].	
Immunosuppressive medications also have a lot of other organ-specific side effects:	
HTN/DM	
[[GERD (Gastroesophageal Reflux Disease)]]/[[Gastritis]]/[[Gastroparesis]] (from MMF, [[Steroid]]).	
[[Osteoporosis (T-score: > -2.5)]] – easy fractures on the ddx	
Renal: 25% will develop CKD w/in 1 year. This is from the [[[[CaN (Calcineurin)]] Inhibitor]].	
Management:	
get a tacro/CSA level if they are having an AKI; otherwise, not useful.	
Hold immunosuppression until d/w transplant team	
Give stress dose [[Steroid]] IF on [[Prednisone]].	
BSA and consider [[Anti-Fungal]] especially if infection source considered to be pulmonary, or if they’ve had prior [[Fungal Infections]]	
MDM – [[Vaginal Bleeding]], NONPREGNANT	
MDM	
This patient presents with *** days [[Vaginal Bleeding]] most likely of nonemergent etiology.	
ED Workup: CBC, BMP, UA, [[B-hCG (Beta (Subunit) Human Chorionic Gonadotropin)]], Type&Screen	
Based on History, Exam, and ED Workup patient’s presentation not consistent with [[EP (Ectopic Pregnancy)]], [[Molar Pregnancy]], life-threatening coagulopathy, trauma, serious bacterial infection, central process or other emergency.	
Most likely, patient’s bleeding is secondary to [[Fibroid (Leiomyoma)]] or other non-emergent cause of [[AUB (Abnormal Uterine Bleeding)]].	
Disposition: Will discharge home with return precautions and instruction for prompt OBGYN follow up.	
*courtesy tydotphrase.wordpress.com	
MDM – VOMITING W VPS (PEDS)	
MDM, Peds	
Differential diagnosis includes VPS malfunction or infection producing [[↑ ↑ ↑ ICP (Intracranial Pressure) ↑ ↑ ↑]]. Other dagnerous causes of acute vomiting are also on the differential including [[Pyloric Stenosis (Gastric Outlet Obstruction, GOO)]], [[Intussusception]], [[Appendicitis]] or SBO although in this patient they are unlikely. Considered viral syndromes (URI, [[Gastritis]], [[Gastroenteritis]]) as well as other non-emergent causes of vomiting.	
Given this patient’s shunt, will evaluate with shunt series // CT // limited MRI, discuss with neurosurgery for possible tap, supportive care, reassess.	
MDM – WITHDRAWAL	
MDM	
This _ patient presents with tremulousness, vomiting, and recent ETOH abuse suspicious for withdrawal. DDx includes intoxication, other toxidromes or withdrawal states, infection, metabolic derangements. Nontoxic appearing_. Considered other causes of patient’s vital sign abnormalities including primary cardiopulmonary etiologies such as ACS, PE, PNA but think these are unlikely. Doubt acute intraabdominal process.	
Plan: BZDs, fluid resuscitation, labs, monitoring, _	
MDM – WRIST PAIN (PEDS)	
MDM, Peds	
This patient presents with wrist pain after a trauma, suspicious for a Salter-Harris fracture. Will obtain plain films to evaluate; ortho consultation for high-grade or unstable fracture patterns, pain control, reassessment. Will likely splint with follow up in ortho clinic pending reassessment.	
Pearls: SALTR	
Grade 1: Straight: usually can’t see on XR	
Grade 2: Above the physis (away from the joint)	
Grade 3: Lower – below the physis (near the joint)	
Grade 4: Through – through the physis. Unstable; will need operative repair.	
Grade 5: Crush/Compression injury. Rare; difficult to pick up on initial XR. Usually from axial load force to extremity. Must consult ortho ASAP.	
February 19, 2019 Leave a comment	
MDM – WRIST PAIN (PEDS)	
MDM, Peds	
This patient presents with wrist pain after a trauma, suspicious for a Salter-Harris fracture. Will obtain plain films to evaluate; ortho consultation for high-grade or unstable fracture patterns, [[Pain Control]], reassessment. Will likely splint with follow up in ortho clinic pending reassessment.	
Pearls: SALTR	
Grade 1: Straight: usually can’t see on XR	
Grade 2: Above the physis (away from the joint)	
Grade 3: Lower – below the physis (near the joint)	
Grade 4: Through – through the physis. Unstable; will need operative repair.	
Grade 5: Crush/Compression injury. Rare; difficult to pick up on initial XR. Usually from axial load force to extremity. Must consult ortho ASAP.	
February 19, 2019 Leave a comment	
MDMAMA	
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.	
MDMANKLE	
Neurovascularly intact. Query likely ankle sprain. Discussed conservative measures including rest, elevation, alternating application of ice, [[Pain Control]] and early ambulation as tolerated. No gross ankle instability. No evidence of maison-neue. Discussed follow up with PMD and given resources for ortho/sports medicine follow up as needed. Discussed strict return precautions for neurovascular insufficiency or need for repeat imaging/evaluation if pain not vastly improved in 5-7 days for possible occult fracture.	
MDMAOM	
Patient with likely [[AOM (Acute Otitis Media)]] given history and exam. No overt e/o [[Mastoiditis]] or [[Malignant (Necrotizing) Otitis Externa]]. Nontoxic appearing with low suspicion for intracranial extension. Tolerating PO, low suspicion for concurrent serious bacterial infection. Will discharge home with [[Amoxicillin (MOXATAG)]] (high dose), auralgan, tylenol, follow up peds_. Cautious return precautions discussed w/ full understanding.	
MDMAlcohol	
Patient presents with acute alcohol intoxication without evidence of co-ingestion or trauma per history and exam. Will observe patient in ED with frequent monitoring and reassessment. Plan to PO trial, reassess mental status, and assess gait when more stable. No evidence of withdrawal currently.	
MDMAllergicDermatitis	
Patient with rash likely allergic or contact dermatitis in nature given history, temporal nature and appearance. No mucous membrane involvement with low suspicion for SJS/TEN. No [[Wheez(-e -es; -ing)]] or difficulty breathing with low suspicion for systemic involvement. Unclear trigger but discussed close monitoring for progression. Will prescribe single dose of steroid given extent of rash and [[Hydrocortisone (Synthetic Cortisol; CORTAID)]] cream_. Cautious return precautions discussed w/ full understanding. No overt e/o superinfection. Prompt follow up with primary care physician discussed.	
MDMAnticholingericIngestion	
with [[AMS (Altered Mental Status)]] and ingestion of multiple medications as above_. Patient appearing dry (dry MM, anhidrotic), tachycardic (sinus on EKG with largely normal intervals), flushed peripherally with [[←←← Pupil →→→]] and delirium with high suspicion for [[Anti-Cholinergic]] component, potentially from _. Given [[Hyperthermia]], likely secondary to anhydrotic hyperthermia and less likely [[Cerebritis; Encephalitis]] or [[CNS (Central Nervous System) Infection]] given exam and history, will start with evaporative cooling measures. Given [[Myoclonus]] and agitation, will give [[Benzodiazepine]], which will also aid to prevent [[Seizure]] secondary to possible [[Na+ (Sodium; 135-145 mEq/L)]] channel blockade (no [[ECG; EKG (Electrocardiogram; Elektro-Kardiographie)]] evidence thus far) or [[AWS (Alcohol Withdrawal Syndrome)]]. Will place foley given AMS and possible [[Urinary Retention]]. Given AMS and unclear history, will obtain CT brain and C-spine to evaluate for ICH_. Given limited exam, will obtain XR chest to evaluate for concretions_. Given likely intentional overdose, will check [[Acetaminophen; (Acetyl-Para-Aminophenol, PAPA); (PARACETAMOL); (TYLENOL)]] level and provide sitter with medical detainment until formal psychiatric evaluation_. Accucheck, Chem 7, and CBC to evaluate for possible metabolic perturbances_. Seizure precautions for possible [[AWS (Alcohol Withdrawal Syndrome)]] and monitor for respiratory and mental status for _ overdose. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Finally, will contact poison control; continue fluid rehydration, trend CK given period of immobilization_. Reassess.	
MDMAnticholingericIngestion	
with [[AMS (Altered Mental Status)]] and ingestion of multiple medications as above_. Patient appearing dry (dry MM, anhidrotic), tachycardic (sinus on EKG with largely normal intervals), flushed peripherally with [[←←← Pupil →→→]] and delirium with high suspicion for [[Anti-Cholinergic]] component, potentially from _. Given [[Hyperthermia]], likely secondary to anhydrotic hyperthermia and less likely [[Cerebritis; Encephalitis]] or [[CNS (Central Nervous System) Infection]] given exam and history, will start with evaporative cooling measures. Given [[Myoclonus]] and agitation, will give [[Benzodiazepine]], which will also aid to prevent [[Seizure]] secondary to possible [[Na+ (Sodium; 135-145 mEq/L)]] channel blockade (no [[ECG; EKG (Electrocardiogram; Elektro-Kardiographie)]] evidence thus far) or [[AWS (Alcohol Withdrawal Syndrome)]]. Will place foley given AMS and possible [[Urinary Retention]]. Given AMS and unclear history, will obtain CT brain and C-spine to evaluate for ICH_. Given limited exam, will obtain XR chest to evaluate for concretions_. Given likely intentional overdose, will check [[Acetaminophen; (Acetyl-Para-Aminophenol, PAPA); (PARACETAMOL); (TYLENOL)]] level and provide sitter with medical detainment until formal psychiatric evaluation_. Accucheck, Chem 7, and CBC to evaluate for possible metabolic perturbances_. Seizure precautions for possible [[AWS (Alcohol Withdrawal Syndrome)]] and monitor for respiratory and mental status for _ overdose. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Finally, will contact poison control; continue fluid rehydration, trend CK given period of immobilization_. Reassess.	
MDMAnticholingericIngestion	
with [[AMS (Altered Mental Status)]] and ingestion of multiple medications as above_. Patient appearing dry (dry MM, anhidrotic), tachycardic (sinus on EKG with largely normal intervals), flushed peripherally with [[←←← Pupil →→→]] and delirium with high suspicion for [[Anti-Cholinergic]] component, potentially from _. Given [[Hyperthermia]], likely secondary to anhydrotic hyperthermia and less likely [[Cerebritis; Encephalitis]] or [[CNS (Central Nervous System) Infection]] given exam and history, will start with evaporative cooling measures. Given [[Myoclonus]] and agitation, will give [[Benzodiazepine]], which will also aid to prevent [[Seizure]] secondary to possible [[Na+ (Sodium; 135-145 mEq/L)]] channel blockade (no [[ECG; EKG (Electrocardiogram; Elektro-Kardiographie)]] evidence thus far) or [[AWS (Alcohol Withdrawal Syndrome)]]. Will place foley given AMS and possible [[Urinary Retention]]. Given AMS and unclear history, will obtain CT brain and C-spine to evaluate for ICH_. Given limited exam, will obtain XR chest to evaluate for concretions_. Given likely intentional overdose, will check [[Acetaminophen; (Acetyl-Para-Aminophenol, PAPA); (PARACETAMOL); (TYLENOL)]] level and provide sitter with medical detainment until formal psychiatric evaluation_. Accucheck, Chem 7, and CBC to evaluate for possible metabolic perturbances_. Seizure precautions for possible [[AWS (Alcohol Withdrawal Syndrome)]] and monitor for respiratory and mental status for _ overdose. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Finally, will contact poison control; continue fluid rehydration, trend CK given period of immobilization_. Reassess.	
MDMAnxietyPanicAttack	
presenting with increased anxiety with clear trigger now resolved. Given exam and history, low suspicion for acute cardiopulmonary process including dissection, ACS, or PE. Denies any acute ingestions and denies any other medical complaints at this time. Does not endorse any [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Engages with conversation. Mood and affect are congruent. Thoughts are linear and organized, and has no AH or HI. No acute need for psychiatric consultation and patient without SI or HI. Clinically no overt toxidrome, well appearing, low suspicion for ingestion given history and exam. Contracted for safety as well as demonstration of significant insight for finding homeless shelter and follow up. Cautious return precautions discussed w/ full understanding.	
MDMApicalAbscessBlock	
Patient with _ apical abscess over _lower right posterior molar presenting for [[Pain Control]]. Patient well appearing, no [[Tetanus (Tetany; Trismus; Lockjaw)]] or airway involvement. No systemic symptoms and no overt e/o deep space extension. Mutual [[Decision Making]] to perform inferior alveolar [[Nerve Block]] for temporary relief and continued control with short course of [[NSAID (Non Steroidal Anti Inflammatory Drug)]] and opiates as outpatient_. Apical abscess I+D extended and small amount of pus expressed with [[Decompression]] of lesion. Low cost dental resources given. Cautious return precautions discussed w/ full understanding.	
MDM[[Asthma]]	
Patient presenting with [[SOB (Shortness of Breath)]]. Given exam and history, suspect likely acute [[Asthma Exacerbation]] without_ [[Status [[Asthma]]ticus]]. These [[Constellation]] of symptoms are similar to prior flares without overt deviations from normal exacerbations. Given clinical findings and history, low suspicion for pneumonia, [[PTX (Pneumothorax)]], or acute valvular failure. Patient with minimal risk factors for [[PE (Pulmonary [[Embolism]]/ous)]] and atypical ACS. As such, will trial bronchodilators, [[Steroid]], monitor respiratory status closely, reassess.	
MDMBackPain	
Patient presents with several days_ of [[Lower [[Back Pain (Dolor)]]]], atraumatic, afebrile.	
Given history and exam, suspect likely [[MSK (Musculoskeletal)]] etiology_.	
Nontoxic appearing and no overt risk factors for [[EDH (Epidural Hematoma)]] or abscess.	
No overt e/o [[CES (Cauda Equina Syndrome)]] or acute critical cord compression with nonfocal neuro exam.	
Neurovascularly intact distally.	
No e/o prostatitis or [[Fournier Gangrene]].	
No peritoneal signs or [[Abdominal Pain]] on exam with low suspicion for AAA.	
MDMBartholins	
Patient with _ [[Bartholin Gland Cyst]] with concurrent [[Bartholin Gland Abscess]] formation.	
No overt evidence of [[Fournier Gangrene]] or deep space involvement. No systemic symptoms.	
Small medial incision made with copious drainage of pus.	
Insertion of [[Word Catheter]] to maintain tract and follow up with OB/GYN discussed.	
[[Wound Care]] and return precautions discussed.	
MDMBetaBlockerIngestion	
Given [[Beta (Adrenergic) Blocker]] overdose, will continue [[Cardiac Monitor]] although no initial evidence of [[PR Prolongation]] or any brady[[Dysrhythmia]]; also not bradycardic or [[Hypotensive]]; will check lytes for possible mild [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]] and [[↓Glucose↓]]. No acute indication at this time for [[Beta (Adrenergic) Blocker]] overdose treatment including [[Atropine (ATROPEN)]], glucagon, [[Ca (2+(+)) (Calcium)]], [[Vasopressor]], high-dose [[INS (Insulin)]] (with glucose), or lipid emulsion therapy. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Will contact poison control; continue fluid rehydration. Reassess.	
MDMBetaBlockerIngestion	
Given [[Beta (Adrenergic) Blocker]] overdose, will continue [[Cardiac Monitor]] although no initial evidence of [[PR Prolongation]] or any brady[[Dysrhythmia]]; also not bradycardic or [[Hypotensive]]; will check lytes for possible mild [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]] and [[↓Glucose↓]]. No acute indication at this time for [[Beta (Adrenergic) Blocker]] overdose treatment including [[Atropine (ATROPEN)]], glucagon, [[Ca (2+(+)) (Calcium)]], [[Vasopressor]], high-dose [[INS (Insulin)]] (with glucose), or lipid emulsion therapy. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Will contact poison control; continue fluid rehydration. Reassess.	
MDMBetaBlockerIngestion	
Given [[Beta (Adrenergic) Blocker]] overdose, will continue cardiac monitor although no initial evidence of [[PR Prolongation]] or any brady[[Dysrhythmia]]; also not bradycardic or [[Hypotensive]]; will check lytes for possible mild [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]] and [[↓Glucose↓]]. No acute indication at this time for [[Beta (Adrenergic) Blocker]] overdose treatment including [[Atropine (ATROPEN)]], glucagon, [[Ca (2+(+)) (Calcium)]], [[Vasopressor]], high-dose [[INS (Insulin)]] (with glucose), or lipid emulsion therapy. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Will contact poison control; continue fluid rehydration. Reassess.	
MDMBlackWidow	
Patient with possible latrodectus envenomation to dominant hand_ several hours prior. Now with [[Constellation]] of symptoms, potentially consistent with mild envenomation including diffuse pain in extremity. Hand with possible area of early cellulitis but no frank abscess formation. Will treat with doxy given allergy profile after conversation with pharmacist. Area of inoculation without local [[Sweating]]. No overt evidence of necrosis or abscess. No cardiothoracic symptoms, no peritoneal signs. At this time, will trial [[Pain Control]] and muscle relaxants. Will continue to monitor and will hold antivenom at this time. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] up to date.	
MDM[[CHF (Congestive v[[HF (Heart Failure)]])]]	
with worsening [[SOB (Shortness of Breath)]] over the past few weeks with [[Constellation]] of symptoms concerning for possible [[CHF (Congestive v[[HF (Heart Failure)]])]] exacerbation. Patient not overtly hypoxic with minimal [[Respiratory Distress]]. No overt evidence of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] on EKG. Will trial [[Nitroglycerin(e)]] for afterload reduction, [[Diuresis]] with strict I/O presuming no evidence of AKI or cardiorenal syndrome_. Trend troponin although low suspicion for [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] given history and exam_. Low suspicion for acute PE given exam and history. Given decline in functional status, consider admission for [[Diuresis]] and further cardiac evaluation_.	
MDMChestPainLowRisk	
with history of tobacco abuse, otherwise healthy, p/w atypical chest pain, subacute worsening of [[Chronic Pain]]. No overt risk factors for ACS and serial EKGs and troponins without overt e/o [[NSTEMI (Non ST (Segment) Elevation [[MI (Myocardial Infarction)]])]]. Pain reproducible on exam with likely [[MSK (Musculoskeletal)]] component. Low Wells score with low risk for PE and no significant hypoxia_. Given chronicity, low s/f dissection. [[Pain Control]]led, well appearing. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
MDMChestPainNoTrop	
p/w atypical chest pain, subacute onset of atypical chest pain. No overt risk factors for ACS aside from HLD_ and EKG w/o overt e/o [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]]. Pain reproducible on exam with likely [[MSK (Musculoskeletal)]] component. Low Wells score and PERC negative with low risk for PE and no significant hypoxia. Given duration, low s/f dissection. [[Pain Control]]led, well appearing. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
MDMChestPainObs	
Patient presents with chest pain without signs of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] on ECG. Patient given aspirin and is currently chest pain free. Low Wells score with low risk for PE and no significant hypoxia_. Given exam and history, low suspicion for dissection. No ectopy noted on monitor and patient well appearing. Had conversation with pt at length regarding risks vs benefits of admission to obs for chest pain. Mutual [[Decision Making]] for patient to be admitted to obs, and agrees to workup. Low suspicion for overt ACS but given age and persistence of symptoms, plan to admit to obs for [[Serial Troponin]], serial EKGs, and risk stratification as inpatient.	
MDM[[Clavicular]]Fracture	
Patient with L_ minimally displaced [[Clavicular]] fracture after falling onto L side. Distally neurovascularly intact in extremities. No overt evidence of significant head trauma. Mentating well with non-focal neurologic exam. Placed in sling and [[Adhesive Capsulitis (Frozen Shoulder Syndrome)]] precautions discussed. Follow up with pediatric orthopedics. Return precautions.	
MDMConcussion	
presenting s/p minor head trauma with headache, lightheadedness, and nausea_. Given mechanism and nonfocal neurologic exam, low suspicion at this time for ICH or significant C-spine injury. Concussion care and precautions discussed. After extensive discussion with patient and family_ regarding observation versus CT and risks and benefits of both, mutual decision making to observe and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Patient with nonfocal neurologic exam and with low suspicion for overt ICH. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.	
MDMCornealAbrasion	
presenting with 1 day of left [[Eye Pain]]_ after irritation yesterday. Patient is a contact lens-wearer. Visual acuity otherwise preserved. Given exam and history, no overt evidence of scleritis, purulent conversion, or [[Cornea(l) Ulcer(ation)(s)]]. Patient does however have small corneal abrasion, which will be treated with antibiotic eyedrops_. Patient to avoid wearing contacts in interim and prompt follow up with ophthalmology discussed.	
MDMDentalFractures	
Patient without overt maloccusion and given mechanism and history, low suspicion at this time for significant mandibular or maxillary fracture and will defer imaging at this time. Prompt follow up with plastics arranged and discussed. In regards to fractured dentition, likely Ellis II_, patient with access to [[Dentist]] in 24 hours and after R/B/A discussed, patient deferred antibiotics and cementing of tooth which is reasonable given degree of fracture and prompt follow up. Strict return precautions discussed.	
MDMDiplopiaBenign	
with isolated episode of binocular_ diplopia now resolved with nonfocal neuro exam with low suspicion for TIA.	
Patient with minimal neurovascular/CVA risk factors and with prompt follow up with neurology already arranged.	
Low suspicion given exam and history for CNS or facial infection including meningitis or [[CST (Cavernous Sinus Thrombosis)]] (no facial tenderness, ptosis and no limitation of [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]], IV, V, VI) , aneursym (no e/o [[CN3 (Cranial Nerve III) Palsy]], headache, no personal or family history).	
No e/o Horner’s syndrome or inflammatory process (i.e. GBS/MF, myasthenia, or temporal arteritis).	
Exam and history with no overt e/o monocular diplopia with low suspicion for acute media or refractive pathology, [[Optic Neuritis]], or uveitis.	
MDMElbowSprain	
with elbow pain after fall. X-ray does not reveal any overt fractures. Discussed discharge instructions with patient and return precautions. Given sling for comfort and [[Adhesive Capsulitis (Frozen Shoulder Syndrome)]] precautions discussed. No overt e/o [[Compartment Syndrome]] or [[Supracondylar Fracture]]. Distally NVI per routine. Patient is well-appearing, in no apparent distress, and vital signs stable for discharge home. Return precautions for occult fracture and return for repeat imaging if needed discussed.	
MDMFallMild	
Patient with ground level fall _ without frank head trauma and non-focal neurologic exam. Patient with multiple abrasions but no lacerations requiring repair_. Affected areas inspected, irrigated and dressings applied. [[Wound Care]] discussed. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] up to date. Patient initially with mild headache_, single episode of emesis_ without frank abdominal injury and [[Shoulder Pain]], now resolved_. Given nonfocal exam and currently well appearing, query possible mild concussive symptoms_. As above, given mechanism and nonfocal neurologic exam, low suspicion at this time for ICH or significant C-spine injury. Concussion care and precautions discussed. After extensive discussion with patient and companion regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or basilar [[Skull Fracture]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Friend agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.	
MDM[[GERD (Gastroesophageal Reflux Disease)]]	
Patient presents with epigastric_ [[Abdominal Pain]] most likely secondary to [[Dyspepsia (Indigestion)]] or non-acute abdominal etiology.	
No peritoneal signs on abdominal exam.	
Patient’s symptoms near resolved with GI cocktail.	
Patient remains PO tolerant.	
Serial abdominal exam without increase in [[Abdominal Pain]].	
Given exam and history, low suspicion for acute abdominal process,	
such as	
[[Acute Cholecystitis]],	
[[Pancreatitis]],	
perforated viscus,	
atypical [[Appendicitis]]	
torsion.	
Extensive conversation about return precautions and need for follow-up.	
MDM[[Gallstone (Cholelithiasis)]]	
Patient presents with [[Abdominal Pain]] and [[US(G) (Ultra(sound; -sonogram; sonography))]] demonstrates visible [[Gallstone (Cholelithiasis)]].	
Given exam and history, suspect likely uncomplicated_ [[Biliary Colic]].	
Patient is afebrile without overt thickening of the [[Gallbladder]] wall, CBD dilation or [[Pericholecystic Fluid]] suggests the absence of [[Acute Cholecystitis]] or acute biliary obstruction.	
Patient is tolerating PO_ and suspicion for acute pancreatic involvement is low.	
After serial abdominal exams, history and observation, low suspicion at this time for other acute intraabdominal processes, including [[AA (Aortic Aneurysm)]], atypical [[Appendicitis]], [[Diverticulitis]], or bowel obstruction.	
Given resolution of pain and no peritoneal signs on serial exams, will discharge patient home with general surgery follow up and strict return precautions.	
MDM[[Gastroenteritis]]	
presenting with 3 days_ of vomiting and [[Diarrhea]].	
Currently [[(Iso;Eu)volemia]] without any abdominal tenderness or peritoneal signs.	
Nontoxic appearing; query possible [[Gastroenteritis]].	
Patient also with URI symptoms and a cough over past several days – suspect viral etiology and will low suspicion for pneumonia at this time_.	
Nausea control, rehydrate, serial abdominal exam, reassess.	
At this time, given initial history and exam, low suspicion for torsion, PID, atypical [[Appendicitis]] or [[Cholecystitis]].	
MDMHIVExposure	
otherwise healthy with moderate risk HIV exposure (unprotected vaginal sex with HIV+ patient albeit with unclear last CD4 + VL)_. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]]/C, RPR, G/C and HIV and relative rates given source patient and mechanism. Patient declining vaginal exam to evaluate for tears at this time after risks discussed with full understanding and capacity. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given risk of transmission, mutual [[Decision Making]] to use PEP at this time. Discussed prompt follow up with clinic for bloodwork and serial serologies. Discussed at length regarding consensual nature of sex and patient does not feel that encounter was not consensual. Discussed that if patient changes mind, given STI treatment center resources. Patient contracts to safety and feels safe at home.	
Given history, per CDC (2013) and NYSDOH (2014), patient not pregnant and will treat with Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Either Raltegravir 400 mg PO twice daily. Discussed post exposure testing at baseline6 weeks post-exposure, 12 weeks post-exposure. 6 months post-exposure at clinic. Will provide 5 days of PEP_ but discussed prompt need for follow up and full course being at least 4 weeks. Cautious return precautions discussed w/ full understanding.	
MDMHeadLac	
not on [[Anti-Coagulation]]_ with resultant laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] updated. NVI distally. Relatively clean wound, irrigated copiously and repaired in simple fashion with dermabond. No antibiotics indicated at this time. Given mechanism and nonfocal neurologic exam, low suspicion for ICH or significant c-spine injury. Discussed strict return precautions and [[Wound Care]].	
MDMHydroflouricAcid	
who presents with right hand paraesthesias s/p possible exposure to HF 14 hours ago. Given duration of symptoms and history of exposure, likely low risk dermal exposure.	
In brief, [[HF (Hydrofluoric Acid)]] is usually found as a rust remover, used in glass etching or in the manufacture of silicon chips.	
While there is a higher risk of co-exposure with other acids in the workplace, this was likely not the case in regards to our patient.	
HF is both a dermal and respiratory irritant, however in our case, as patient was using a hood and given the questionable exposure, there is a low suspicion for cardiopulmonary symptoms at this time. As such, our patient currently does not demonstrate any overt inhalational symptoms including chemical pneumonitis or [[NCPE (Non CPE (Cardiogenic PE (Pulmonary Edema)))]]. While the concentration of HF exposure is unknown, if an exposure were to have happened, it is likely a weak or intermediate concentration as there currently is no overt signs of dermal injury. However, in weaker concentrations, there may be a delay of symptoms owning to the penetration of deeper tissues by the cytotoxic fluoride ions. As above, despite the low risk nature of exposure and relatively benign exam, after further discussion with poison control, we will obtain labs to evaluate for systemic [[↓↓↓ Calcium (Ca2+) ↓↓↓ (Hypocalcemia)]], [[↓↓↓ [[Mg2+ (Magnesium)]] ↓↓↓]] and [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]]. In the interim, the potential affected area will be irrigated extensively and if labs are unremarkable, given the time frame and history, will likely recommend continuation of topical [[Calcium Gluconate]] gel using a rubber glove to enhance skin penetration. At this time, given the [[Constellation]] of symptoms, duration, non-progressive nature and unclear history of exposure, there is no acute indication for [[SubQ (Subcutaneous)]] or systemic [[Ca (2+(+)) (Calcium)]] administration.	
MDM	
[[HF (Hydrofluoric Acid)]]	
who presents with right hand paraesthesias s/p possible exposure to HF 14 hours ago. Given duration of symptoms and history of exposure, likely low risk dermal exposure. In brief, [[HF (Hydrofluoric Acid)]] is usually found as a rust remover, used in glass etching or in the manufacture of silicon chips. While there is a higher risk of co-exposure with other acids in the workplace, this was likely not the case in regards to our patient. HF is both a dermal and respiratory irritant, however in our case, as patient was using a hood and given the questionable exposure, there is a low suspicion for cardiopulmonary symptoms at this time. As such, our patient currently does not demonstrate any overt inhalational symptoms including chemical pneumonitis or [[NCPE (Non CPE (Cardiogenic PE (Pulmonary Edema)))]]. While the concentration of HF exposure is unknown, if an exposure were to have happened, it is likely a weak or intermediate concentration as there currently is no overt signs of dermal injury. However, in weaker concentrations, there may be a delay of symptoms owning to the penetration of deeper tissues by the cytotoxic fluoride ions. As above, despite the low risk nature of exposure and relatively benign exam, after further discussion with poison control, we will obtain labs to evaluate for systemic [[↓↓↓ Calcium (Ca2+) ↓↓↓ (Hypocalcemia)]], [[↓↓↓ [[Mg2+ (Magnesium)]] ↓↓↓]] and [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]]. In the interim, the potential affected area will be irrigated extensively and if labs are unremarkable, given the time frame and history, will likely recommend continuation of topical [[Calcium Gluconate]] gel using a rubber glove to enhance skin penetration. At this time, given the [[Constellation]] of symptoms, duration, non-progressive nature and unclear history of exposure, there is no acute indication for [[SubQ (Subcutaneous)]] or systemic [[Ca (2+(+)) (Calcium)]] administration.	
MDM	
[[HF (Hydrofluoric Acid)]]	
who presents with right hand paraesthesias s/p possible exposure to HF 14 hours ago.	
Given duration of symptoms and history of exposure, likely low risk dermal exposure.	
In brief, [[HF (Hydrofluoric Acid)]] is usually found as a rust remover, used in glass etching or in the manufacture of silicon chips.	
While there is a higher risk of co-exposure with other acids in the workplace, this was likely not the case in regards to our patient.	
HF is both a dermal and respiratory irritant, however in our case, as patient was using a hood and given the questionable exposure, there is a low suspicion for cardiopulmonary symptoms at this time.	
As such, our patient currently does not demonstrate any overt inhalational symptoms including chemical pneumonitis or [[NCPE (Non CPE (Cardiogenic PE (Pulmonary Edema)))]]. While the concentration of HF exposure is unknown, if an exposure were to have happened, it is likely a weak or intermediate concentration as there currently is no overt signs of dermal injury.	
However, in weaker concentrations, there may be a delay of symptoms owning to the penetration of deeper tissues by the cytotoxic fluoride ions.	
As above, despite the low risk nature of exposure and relatively benign exam, after further discussion with poison control, we will obtain labs to evaluate for systemic [[↓↓↓ [[Ca (2+(+)) (Calcium)]] ↓↓↓ (Hypocalcemia)]], [[↓↓↓ [[Mg2+ (Magnesium)]] ↓↓↓]] and [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]].	
In the interim, the potential affected area will be irrigated extensively and if labs are unremarkable, given the time frame and history, will likely recommend continuation of topical [[Calcium Gluconate]] gel using a rubber glove to enhance skin penetration.	
At this time, given the [[Constellation]] of symptoms, duration, non-progressive nature and unclear history of exposure, there is no acute indication for [[SubQ (Subcutaneous)]] or systemic [[Ca (2+(+)) (Calcium)]] administration.	
MDMKneePain	
subacute worsening of chronic [[Right Knee Pain]].	
Atraumatic. Neurovascularly intact distally.	
Given [[Focal Tenderness]], query possible MCL strain vs [[Bursitis]].	
No systemic symptoms and nontoxic; given exam and history, low suspicion for [[Septic Arthritis]], pyomyositis or [[NF (Necrotizing Fasciitis)]].	
No e/o [[Compartment Syndrome]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].	
MDMKneePainTrauma	
with R_ knee pain and mild swelling after injury. Neurovascularly intact distally. Given [[Focal Tenderness]], query possible ligamentous injury however no gross instability. No tibial plateau tenderness. XR without frank fracture. Low suspicion for [[Vascular Injury]] with dislocation-relocation. No ankle or [[Hip Pain]]. No [[Back Pain (Dolor)]] with low supicion for significant axial load. No systemic symptoms and nontoxic; given exam and history, low suspicion for [[Septic Arthritis]], pyomyositis or necrotizing fascitis. No e/o [[Compartment Syndrome]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]. [[Pain Control]]. Follow up with PMD and ortho as needed. Cautious return precautions discussed w/ full understanding.	
MDMLacChin	
with chin injury and superficial arm abrasions s/p fall from scooter_ prior to arrival. Pt with resultant chin laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] UTD. No maloccusion with low suspicion for mandibular fracture. No LOC and low suspicion for ICH. Relatively clean wound, irrigated copiously and repaired in simple fashion with sutures. No antibiotics indicated at this time. Discussed strict return precautions, follow up for suture removal and [[Wound Care]]. Extremity exam with full range of motion, no [[Bony Tenderness]] and distally neurovascularly intact.	
MDMLacGen	
with resultant laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] updated. XR w/o overt e/o fracture. NVI distally. Relatively clean wound, irrigated copiously and repaired in simple fashion with staples_. No antibiotics indicated at this time. NVI per routine post repair. No overt e/o [[Compartment Syndrome]]. Discussed strict return precautions, follow up for staple removal and [[Wound Care]].	
MDMLacRepair	
Wound inspected under direct bright light with good visualization.	
Area with linear laceration across soft tissue through adipose without exposure of muscle belly or tendon_.	
No overt [[Foreign Body]].	
Area hemostatic.	
Neurovascular exam congruent with above.	
Area extensively irrigated with sterile [[0.9% NS; NaCl (Normal Saline; [[Na+ (Sodium; 135-145 mEq/L)]] Cl- (Chloride (95-105))]] under pressure.	
Laceration repaired in simple fashion as below (please see procedure note for further details)_.	
Patient tolerated procedure well and neurovascular exam intact and unchanged post repair with intact distal pulses and cap refill_.	
Cautious return precautions discussed w/ full understanding.	
[[Wound Care]] discussed.	
Prompt follow up with primary care physician discussed and return for suture removal.	
MDMMVALowSpeed	
otherwise healthy involved in restrained MVA with airbag deployment. Patient with pain predominantly to L paraspinal and L [[Clavicular]] area_. [[Hemodynamic]]ally appropriate with nonfocal neurologic exam. Given exam and history, low suspicion for traumatic dissection or ICH. CT c-spine without overt fracture or dislocation with low suspicion for ligamentous injury on re-examination. Serial abdominal exam without tenderness and FAST initially unremarkable. Observed for several hours in ED with clinical improvement. Stable gait and tolerating PO. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
MDM[[Migraine (Headache)]]	
with history of chronic intermittent [[Migraine (Headache)]], recently started on triptan_, now presenting with similar [[Constellation]] of symptoms without overt evidence and low suspicion for [[ICH (Intracranial Hemorrhage)]], [[SAH (Subarachnoid Hemorrhage)]], or CNS affection. Patient with non-focal neuro exam. Patient not immunocompromised and no family history of bleeding dyscrasias or aneursymal rupture. Headache slow onset and similar to prior exacerbations. Will attempt [[Pain Control]], serial neuro exams, and reassess.	
MDMNeckPainTrauma	
with no pertinent history presents with now resolving R_ paraspinal neck pain. No acute findings on exam; in particular, no midline spinal tenderness to palpation. Non-focal neuro exam with sensation and strength intact and equal bilaterally. Low suspicion for cervical ligamentous or [[Vascular Injury]]. Intact grips and UE exam with low suspicion for central cord. Discussed [[Pain Control]], observation of symptoms. Cautious return precautions discussed w/ full understanding.	
MDMNeckSwelling	
Patient otherwise healthy_, fully vaccinated_ with anterior neck swelling likely secondary to significant lymphadenopathy of limited duration with suspicion for likely viral etiology. BUS with visualization of LAD without frank abscess. Mild [[Tetanus (Tetany; Trismus; Lockjaw)]] on exam but no overt e/o PTA or RPA. No overt e/o deep space infection; nontoxic appearing and tolerating PO. Non-focal neuro exam with low suspicion for [[Lemierre Syndrome]]. Vaccinated with low suspicion for mumps. Low suspicion for malignancy or goiter formation at this time given duration but discussed prompt follow up to reassess. Trial antibiotics_ and [[Steroid]]_ with cautious return precautions discussed w/ full understanding. Airway fully patent.	
MDMPECARNAbdominalTrauma	
Patient denies severe mechanism of injury. Patient does not have overt evidence of abdominal wall trauma or [[Seat Belt]] sign. Patient is currently alert and at baseline mental status and activity level per family. Patient denies any abdominal tenderness and does not have evidence of thoracic wall trauma. Breath sounds remain equal bilaterally. Denies nausea or vomiting.	
MDMPECARNHead	
Patient is currently at baseline mental status and activity level per family. Patient does not have evidence of palpable skull fractures or step offs. Patient does not have an occipital, parietal or temporal hematoma. Denies LOC > 5 seconds. No signs of basilar skull injury including [[Raccoon eyes]], [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], CSF rhinorrhea or hemotympanum. No nasal hematoma. Denies vomiting or headache. Denies severe mechanism of injury.	
MDMPEDS[[Appendicitis]]NoScan	
Patient with [[Abdominal Pain]] and vomiting, now resolved_. No peritoneal signs with low suspicion for acute intraabdominal process including torsion, SBO, [[Intussusception]] or atypical [[Appendicitis]]. Serial abdominal exams throughout course without increase in pain or migration of pain. Tolerating PO in ED. US appendix inconclusive_. After extensive discussion with family regarding observation versus CT versus return for recheck in 8-12 hours if not resolved and risks and benefits of options, mutual [[Decision Making]] to return for recheck given relative improvement and well appearing child with alternative diagnoses (_) for fever and [[Malaise]] and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of peritoneal involvement. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting, increase in [[Abdominal Pain]], or altered behavior. Will discuss prompt follow up with PMD and strict return precautions discussed.	
MDMPEDSBurn	
with no previous medical history presents brought in by parents for superficial scattered burns primarily to torso_ with minimal BSA involved. Burns superficial, consistent with history and given interaction observed between parents, low suspicion at this time for NAT. Parents and patient appropriate. Patient undressed fully without any suspicious lesions. Discussed [[Wound Care]], [[Pain Control]] and follow up with PMD. Return precautions for superinfection. Patient at baseline currently without significant burns over scalp, face, groin or distal extremities. Cautious return precautions discussed w/ full understanding.	
MDMPEDSFussy	
otherwise healthy, full term, brought in by parents for 1 day_ of increased fussiness. Afebrile, full term, currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing [[(Iso;Eu)volemia]] with appropriate linear [[Weight Gain]] since birth. No meningismus, otherwise at baseline activity level with low suspicion for [[CNS (Central Nervous System) Infection]]. Patient wearing mittens_, no excessive tearing or redness, and without long nails with low suspicion for [[Corneal Abrasion]]. No overt evidence of NAT or hair tourniquets. No malignant rashes noted and improving [[Diaper Rash]] per parents on exam. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of [[CNS (Central Nervous System) Infection]] including but not limited to changes in mental status or vomiting, or fever. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.	
MDMPEDSRash	
fully immunized, otherwise healthy, p/w isolated rash likely due to viral exantham_ given history, temporal nature and appearance. No mucous membrane involvement with low suspicion for SJS/TEN. No [[Wheez(-e -es; -ing)]] or difficulty breathing with low suspicion for systemic involvement. Low suspicion for scabies given history and exam. Discussed close monitoring for progression. Cautious return precautions discussed w/ full understanding. No overt e/o superinfection. Prompt follow up with primary care physician discussed.	
MDMPEDSURI	
with vaccinations up to date_, full term, otherwise healthy boy presenting with fever and [[Constellation]] of upper respiratory symptoms. Currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing [[(Iso;Eu)volemia]]. Mild fever and well appearing after [[Ibuprofen; ((ADVIL), (MOTRIN))]] administration. No meningismus, otherwise at baseline activity level with low suspicion for [[CNS (Central Nervous System) Infection]]. Query likely viral etiology. Discussed low risk but possible UTI and offered catherterized urine sampling, but mutual [[Decision Making]] at this time to defer after discussion with parents_. Discussed alternating tylenol and [[Ibuprofen; ((ADVIL), (MOTRIN))]] as directed over the counter for antipyresis. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of [[CNS (Central Nervous System) Infection]] including but not limited to changes in mental status or vomiting, or fever for more than 5 days. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.	
MDMPEDSUTI	
[[Immunization]]s UTD_, otherwise healthy, not immunocompromised, presenting with fever and [[Malaise]]. [[Constellation]] of symptoms and history concerning for possible UTI_. Patient is extremely well appearing, mentating well, at baseline per parents, lucid and without meningismus. Nonfocal neuro exam with low suspicion for [[CNS (Central Nervous System) Infection]]. No [[Respiratory Distress]] with low suspicion for pneumonia. No [[Abdominal Pain]] and benign abdominal exam with low suspicion for atypical [[Appendicitis]]. No overt findings for vulvovaginitis_. UA with some WBC and + LE_. Given symptoms, will treat with [[Cephalexin (KEFLEX)]]_ for possible upper tract infection. Tolerating PO including juice and crackers in ED. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. [[Appendicitis]] return precautions discussed.	
MDMPEP	
After extensive discussion with patient regarding PEP versus observation/follow up and risks and benefits of both, mutual [[Decision Making]] to provide first dose of PEP and follow up promptly with outpatient testing and further treatment as needed at this time per most recent CDC HIV PEP guidelines for unknown relatively high risk exposures_. Discussed that single dose of PEP is not a substitute for follow up and further care/evaluation. Discussed need for concurrent testing of other STI including, but not limited to, G/C and RPR. Discussed safe sex practices_. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
MDMPEPOccHealth	
with occupational work exposure with relatively low risk of transmission. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]], C and HIV and relative rates given source patient and mechanism. [[Immunization]]s UTD as above, specifically [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] and [[HBV (Hepatitis B (Virus))]] vaccinations. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given relatively low risk of transmission, mutual [[Decision Making]] to defer PEP at this time. Discussed prompt follow up with occupational health for bloodwork and serial serologies as needed.	
MDMPEPOccHealth	
with occupational work exposure with relatively low risk of transmission. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]], C and HIV and relative rates given source patient and mechanism. [[Immunization]]s UTD as above, specifically [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] and [[HBV (Hepatitis B (Virus))]] vaccinations. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given relatively low risk of transmission, mutual [[Decision Making]] to defer PEP at this time. Discussed prompt follow up with occupational health for bloodwork and serial serologies as needed.	
___	
NYSDOH AI Recommendations (2014)	
Indication: Percutaneous or [[Mucocutaneous]] exposure with blood or visibly [[Bloody Fluid]] or other potentially infectious material.	
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily or [[Lamivudine (EPIVIR)]] 300 mg PO daily plus Either Raltegravir 400 mg PO twice daily or [[Dolutegravir (DOVATO)]] 50 mg PO daily	
HIV Antibody Testing of Healthcare Worker	
Baseline	
4 weeks post-exposure	
12 weeks post-exposure	
When a potential [[Occupational Exposure]] to HIV occurs, every effort should be made to initiate PEP, as soon as possible, ideally within 2 hours. A first dose of PEP should be offered to the exposed worker while the evaluation is underway. In addition, PEP should not be delayed while awaiting information about the source or results of the exposed individual’s baseline HIV test.	
Decisions regarding initiation of PEP beyond 36 hours post exposure should be made on a case-by-case basis with the understanding of diminished efficacy when timing of initiation is prolonged.	
CDC Recommendations (2013)	
* Kuhar DT, Henderson DK, Struble KA, et al. Updated U.S. Public Health Service guidelines for the management of [[Occupational Exposure]]s to [[HIV (Human Immunodeficiency Virus)]] and recommendations for postexposure [[Prophylaxis]]. Infect Control Hosp Epidemiol 2013;34: 875-892. Available at: http://stacks.cdc.gov/view/cdc/20711	
Indications: Percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or potentially infectious body fluids, such as semen, vaginal secretions, and visibly [[Bloody Fluid]]s and reasonable suspicion that the source patient is HIV-infected.	
Source Testing:	
Although concerns have been expressed regarding HIV-negative sources being in the window period for seroconversion, no case of transmission involving an exposure source during the window period has been reported in the United States. Rapid HIV testing of source patients can facilitate making timely decisions regarding use of HIV PEP after occupational exposures to sources of unknown HIV status.	
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Raltegravir 400 mg PO twice daily	
Duration of PEP: 4 weeks	
HIV Antibody Testing of Healthcare Worker	
Baseline	
6 weeks post-exposure	
12 weeks post-exposure	
6 months post-exposure	
Alternatively, if the clinician is certain that a fourth-generation antibody/antigen combination assay is being used, then HIV testing could be performed at baseline, 6 weeks, and concluded at 4 months post-exposure.	
PEP should be initiated as soon as possible, preferably within hours rather than days of exposure. Initiation of PEP should not be delayed while awaiting the results of a source patient’s HIV test, nor should it be delayed during consultation with experts to determine ideal PEP regimens.	
Rationale:	
Several clinical studies have demonstrated that HIV transmission can be significantly reduced by the post-exposure administration of [[Anti-Retroviral Therapy]] agents. A dramatic decline in vertical transmission was observed in the AIDS Clinical Trial Group (ACTG) 076 study,1 in which pregnant women and their newborns received monotherapy with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] ([[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]), and in the HIVNET 012 study,2 in which single-dose [[NVP (Nevirapine, VIRAMUNE)]] was compared with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]. A CDC retrospective [[Case Control]] study3 of [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] use after occupational HIV exposure in healthcare workers (HCWs) showed an 81% reduction in risk of [[HIV (Human Immunodeficiency Virus)]] in persons who received [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]].	
Because the ultimate goals of PEP are to maximally suppress any limited viral replication that may occur and to shift the biologic advantage to the host cellular immune system to prevent or abort early infection, the Committee recommends the use of a three-drug PEP regimen for all significant risk exposures.	
Relative Risks:	
Estimated Per-Act Probability of Acquiring HIV From a Known HIV-Infected Source by Exposure Act	
Type of Exposure Risk per 10,000 Exposures	
Parenteral	
Blood Transfusion 9,000	
Percutaneous ([[Needle Stick]]) 30	
Sexual	
Receptive anal intercourse 138	
Insertive anal intercourse 11	
Receptive penile-vaginal intercourse 8	
Insertive penile-vaginal intercourse 4	
Receptive oral intercourse low	
Insertive oral intercourse low	
Other	
Biting Negligible	
Spitting Negligible	
Throwing body fluids Negligible	
(including semen or saliva)	
http://www.cdc.gov/hiv/law/transmission.htm.	
Factors that increase the risk of HIV transmission include early and late-stage [[HIV (Human Immunodeficiency Virus)]] and a high level of HIV in the blood. Factors that reduce the risk of HIV transmission include low level of HIV in the blood and the use of ART.	
MDMPedsChestPainIngestion	
with atypical [[Chest Discomfort]] and now resolved palpitations in the setting of Adderall_ use. No overt risk factors for early cardiac disease; no family history of early cardiac death. Patient well appearing, nontoxic. Low Wells score with low s/f PE; no overt hypoxia. Given history and exam, low suspicion for ACS, dissection, or [[PTX (Pneumothorax)]]. Discussed cessation of Adderall_ and follow up with PMD for further evaluation as needed. Cautious return precautions discussed w/ full understanding.	
MDM[[Pericarditis]]	
with positional chest pain for the past 2 days_. Recent mild cough, [[Sore Throat (Pharyngitis)]]_. EKG obtained consistent with [[Pericarditis]]. BUS w/o overt tamponade or significant effusion. Query possible [[Recent [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]]]] as trigger. No overt e/o AKI or CKD, malignancy, HIV, TB. No overt high risk factors for complicated [[Pericarditis]] including fever, no e/o large pericardial effusion or tamponade, no immunosuppression, [[Anti-Coagulation]], or trauma. Low suspicion given history and exam for concurrent [[Myocarditis]], ACS or PE. Discussed activity restriction until symptom resolution. Discussed treatment with [[NSAID (Non Steroidal Anti Inflammatory Drug)]] ([[Ibuprofen; ((ADVIL), (MOTRIN))]] TID per ESC guidelines) with low risk for GIB (no history of PUD, age < 65, and no concurrent [[Anti-Coagulation]]) and cotreatment with [[Colchicine (MITIGARE, COLCRYS)]] given lack of risk factors for toxicity (low suspicion for CKD given age) and potential benefits (significant reduction in the risk of recurrence – ICAP trial NEJM 2013)_. Discussed need for close follow up with ASHE and cardiology referral as well as strict return precautions for worsening chest pain, signs of [[CHF (Congestive v[[HF (Heart Failure)]])]]/fluid overload/tamponade, or infection.	
MDM	
[[Pre-Eclampsia]]	
history of [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] presents for [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] with SBP _ sent in by PMD with concern for possible [[Pre-Eclampsia]].	
Of note, patient without severe range BP in ED.	
Patient without neuro or ocular concerns at this time.	
No RUQ and no frank proteinuria.	
No seizure activity and without cardiothoracic symptoms..	
Benign abdominal exam and non-focal neuro exam.	
Labs largely reassuring_.	
Therefore, given history and exam, low suspicion at this time for [[Fulminant]] [[Pre-Eclampsia]] requiring admission.	
No overt evidence of HELLP, acute [[Cholestasis]] of pregnancy, or eclampsia at this time.	
Discussed case with OB and after evaluation, will _.	
Cautious return precautions discussed w/ full understanding.	
Prompt follow up with primary care physician/OB arranged and discussed_.	
MDMPsych	
Denies any ingestions and denies any other medical complaints. Does not endorse any [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Engages with conversation. Mood and affect are congruent. Thoughts are linear and organized, and has no AH or HI. Plan admit to psychiatry for further management of symptoms. Will consult psychiatry to evaluate Patient for potential hold for danger to self. Clinically no overt toxidrome, well appearing, low suspicion for ingestion given history and exam.	
MDMRabies	
_ with bat exposure who presents for [[IgA (Ig (Immunoglobulin) A)]]dministration. Patient without obvious wound but given duration of exposure, high risk nature and possible [[Incubation Period]] (of up to 1-3 months), mutual [[Decision Making]] with patient re: R/B/A to give dose of RiG. Per most recent CDC/ACIP guidelines re: PEP for human rabies, patient with 1st of 4-dose rabies vaccination regimen prior to arrival (0, 3, 7, 14; HDCV or PCECV). Discussed need for subsequent doses. Patient without altered immune competence. No obvious inoculation wound, as such, will infiltrate weight based RIG IM_. Patient currently largely asymptomatic with non-focal exam with no symptoms of cerebral dysfunction, anxiety, confusion, agitation, delirium, abnormal behavior, [[Hallucinations]], and [[Insomnia (Nighttime Wakefulness)]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
MDMRenalColic	
Patient presents with flank pain consistent with previous [[Nephrolithiasis ((Kidney; Renal) Stone(s))]] pain. Patient otherwise well-appearing with low suspicion for sepsis, dissection or infected obstructed [[Renal Colic]]. US w/ mild [[Hydronephrosis; Ureterectasis (Hydro;Ureter(o));(nephrosis;ectasis))]] on affected side_. Low suspicion for atypical [[Appendicitis]], torsion, acute chole, or intraabdominal infection. Discussed conservative management, strict return precautions and follow up with urology. Will discharge with [[FLOMAX (Tamsulosin)]]_, [[NSAID (Non Steroidal Anti Inflammatory Drug)]], opiates for breakthrough, strainer, and antiemetics. Patient tolerating PO and [[Pain Control]]led prior to discharge. Strict return precautions for infected stone or PO intolerance discussed. Low suspicion for AKI, obstructive nephropathy given exam and history.	
MDMRetinalDetachment	
Patient presenting with [[Constellation]] of symptoms concerning for vitreous [[Hemorrhage]] vs [[Retinal Detachment]]. Not contact lens wearer_. No prior ocular history_. Patient is headache free and visual acuity intact with low suspicion for [[GCA; TA ((Giant Cell; Temporal) Arteritis)]] or [[CRAO (Central RAO (Retinal Artery Occlusion))]]/CRVO. No vision changes or [[Conjunctival Injection]] with low suspicion for [[Acute Angle Closure]] glaucoma. No trauma to the eye and no sensation of [[Foreign Body]] with low suspicion for [[Cornea(l) Ulcer(ation)(s)]] or globe injury. No evidence of overt [[Hyphema]] or [[Hypopyon(s)]] on exam. No ocular pain or consensual [[Photophobia]] with low suspicion for scleritis or iritis. Plan to discuss case with ophthalmology for dilated exam and further assessment.	
MDMScabies	
subacute rash over months_. Given distribution, characteristics and associated symptoms, likely secondary to scabies vs bedbugs. No overt mucosal involvement w/ low s/f TEN/SJS/EM. No e/o superinfection. Discussed hygiene/de[[Contamination]] measures, continue ivermectin and [[Permethrin]]_; symptomatic t/w [[Diphenhydramine (BENADRYL®)]] and steroid burst. F/u w/ dermatology as discussed. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.	
MDMSepsisGen	
who presents with fever and ¾_ [[Systemic Inflammatory Response Syndrome (SIRS) Criteria]]. Resuscitation via EGDT with 30 cc/kg NS bolus with stabilization in vitals. Empiric [[Antibiotic Therapy]], albeit with modified regimen given suspected intraabdominal source_ and allergy profile_. CXR, cultures, and UA. Consider [[NE (NoreEpi, Norepinephrine, Noradrenaline LEVOPHED)]] if patient not fluid responsive. Monitor [[Hemodynamic]] status. Admit to medicine for further care.	
MDMSepsisImmunosuppressedWell	
s/p [[Renal Transplant]]_ and s/p OHT_ who presents with fever for past several days and intermittent [[Productive Cough]]_. Despite patient being well appearing, will perform septic workup with concern for possible CAP. Will obtain CXR, labs, blood cultures, urine cultures, UA. Will also get troponin (to evaluate for [[Myocarditis]]), BNP (to trend for possible rejection). No overt evidence of fluid overload at this time. No overt hospital acquired risk factors but given immunosuppression and concern for pulmonary cause, will empirically treat with vanc/[[Cefepime (MAXIPIME, VOCO)]]/[[Azithromycin (ZITHROMAX, Z-PACK)]]_ and will defer to medicine team to narrow. Although grafts working well on prior visit, as patient not overtly septic, will gently hydrate with NS given [[Hemodynamic]] stability and propensity for possible graft dysfunction/fluid overload_.	
MDMSepticArthritis	
Given exam and history, low suspicion for septic arthritis at this time given location of pain (not over knee joint but superior to area), subacute nature, and relative comfort to range of motion and axial loading. Nontoxic appearing and no overt systemic symptoms. Atraumatic with low suspicion for fracture or dislocation. No overt e/o [[NF (Necrotizing Fasciitis)]]. Given tenderness and area of erythema, will treat for cellulitis. Neurovascularly intact per routine as above with no overt e/o compartment syndrome.	
After extensive discussion with patient and wife regarding observation and treatment of possible cellulitis versus [[Arthrocentesis]] and risks (overlying cellulitis, lower [[Pre-Test]] probability of [[Septic Arthritis]], risk of inoculation of joint) and benefits of both, mutual [[Decision Making]] to trial antibiotics and not pursue further [[Arthrocentesis]] at this time. Patient tolerating discomfort, continue to be at baseline and well appearing. As above, does not have signs of systemic symptoms or neurovascular compromise. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with increase in pain, inability to range or bear weight, or fevers.	
MDM	
[[Sickle Cell]] VOC	
with history of SSD Hb SS_,	
functionally asplenic_,	
[[Immunization]]s for encapsulated organisms reportedly up to date,	
complicated prior by_ [[Avascular Necrosis]] of humerus and femur,	
and [[Acute Chest Syndrome]] syndrome_,	
last transfusion several months prior_,	
baseline hgb _ now	
presenting with [[Constellation]] of symptoms similar to prior	
acute vasooclusive	
pain crises without overt trigger. Patient is afebrile, not hypoxic and without	
[[Dyspnea]] with low suspicion at this time for [[Acute Chest Syndrome]]. Will trend [[Hb (Hemoglobin)]] and [[Reticulocyte Count]] to evaluate for possible hemolytic vs aplastic crisis, although low suspicion at this time. No overt worsening of [[Avascular Necrosis]] or [[Osteomyelitis]] on exam. Nonfocal neuro exam with low suspicion at this time for end [[Organ Dysfunction]] from VOC including CVA, ACS, AKI or hepatobiliary complications. Will continue to monitor, [[Pain Control]], gentle hydration, and follow up labs.	
MDMStrepThroat	
with otherwise healthy, fully vaccinated with [[Sore Throat (Pharyngitis)]] likely secondary to viral URI vs [[[[Strep(tococc(us;I;al))]] Pharyngitis]]. No [[Tetanus (Tetany; Trismus; Lockjaw)]] on exam and no overt e/o PTA or RPA. No overt e/o deep space infection; nontoxic appearing and tolerating PO. Centor _. Non-focal neuro exam with low suspicion for [[Lemierre Syndrome]]. Trial antibiotics and [[Steroid]] with cautious return precautions discussed w/ full understanding. Tolerating PO and otherwise well appearing.	
MDMStye	
with stye vs chalazion to right upper eyelid. Patient well appearing without overt evidence of septal or pre-septal cellulitis. No overt evidence of [[CST (Cavernous Sinus Thrombosis)]]. Will discharge with recommended warm compresses at home and optho follow-up this week. Low suspicion for [[Foreign Body]] or [[Corneal Abrasion]] given history and exam.	
MDMSyncopeFall	
Patient presents after ground level fall, currently in c-spine precautions with likely LOC_. Unwitnessed fall, with unclear etiology, possible mechanical but cannot r/o syncope at this time. Patient without any [[Prodrome]] symptoms with low suspicion at this time for ACS, dissection or malignant [[Arrhythmia (Abnormal Rhythm)]]. Will check labs for electrolyte protuberances, will obtain CT brain and C-spine to evaluate for ICH as patient is [[Anti-Coagulation]]d_. Given history, low suspicion for ACS, but will obtain troponin and EKG for cardiac evaluation and reassess_. Currently at baseline mental status. No [[Respiratory Distress]] or hypoxia with low suspicion for massive PE at this time. Serial neurologic exams and monitor in interim.	
MDMSyncopeVasoVagal	
who presents with syncope prior to arrival. Witnessed syncope, likely vasovagal in etiology given history and exam. Patient currently at baseline mental status. No chest pain with low s/f dissection or ACS. No hypoxia or tachypnea with no risk factors for PE. No overt e/o malignant [[Arrhythmia (Abnormal Rhythm)]] on serial EKG. Patient not pregnant_. PO challenge. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed for further workup as needed.	
MDMURI	
otherwise healthy presenting with [[Constellation]] of symptoms likely representing uncomplicated viral upper respiratory symptoms as characterized by mild [[Sore Throat (Pharyngitis)]] without overt evidence of RPA/PTA, deep space infection/[[Ludwig Angina (Dental Sepsis)]]’s, or bacterial superinfection_. Low suspicion for CNS infection bacterial sinuitis, or pneumonia given exam and history. Will attempt to alleviate symptoms conservatively; no overt indications at this time for antibiotics. No [[Respiratory Distress]], otherwise relatively well appearing and nontoxic. No peritoneal signs with low suspicion for acute intraabdominal process. Will discuss prompt follow up with PMD and strict return precautions discussed.	
MDMUTIMale	
with with no significant medical history who presents with UTI without overt e/o infected stone or prostatitis. BUS w/o overt e/o [[Hydronephrosis; Ureterectasis (Hydro;Ureter(o));(nephrosis;ectasis))]]_. Rectal w/o e/o abscess formation, deep space infection or prostatitis_. No e/o [[Epididymo-Orchitis]] on exam. Abdomen benign with minimal suprapubic TTP. No CVAT. Febrile, but otherwise well appearing and reliable. Given dose of [[Ceftriaxone (ROCEPHIN)]] and d/c w/ Cipro_. Cautious return precautions discussed w/ full understanding. [[Appendicitis]] and [[Abdominal Pain]] precautions given for return. Prompt follow up with primary care physician discussed.	
PE	
PE Benign	
Hand Exam	
Sensation: SILT in FDWS (radial), SF volar tip (ulnar), and IF (median)	
Motor: + TU (radial), OK sign (median), X 2-3 (ulnar), F&E 1-5 against resistance, Wrist/finger extension off table (radial). Finger AB/AD-duction (ulnar), Thumb to pinky (median).	
Vascular: CR<2s in all digits	
Compartments Soft	
Right hand:	
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.	
Left hand:	
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.	
Isolation of each digit	
IF: FDS, FDP, extenstion intact with PROM and against resistance. No pain on movement. RDN/UDN intact. 2 pt discrimination intact. CR < 2s. Soft compartment. No gross deformity.	
MF: FDS, FDP, extenstion intact with PROM and against resistance. No pain on movement. RDN/UDN intact. 2 pt discrimination intact. CR < 2s. Soft compartment. No gross deformity	
RF: FDS, FDP, extenstion intact with PROM and against resistance. No pain on movement. RDN/UDN intact. 2 pt discrimination intact. CR < 2s. Soft compartment. No gross deformity	
SF: FDS, FDP, extenstion intact with PROM and against resistance. No pain on movement. RDN/UDN intact. 2 pt discrimination intact. CR < 2s. Soft compartment. No gross deformity	
Thumb: FPL, EPL, EPB, APL intact per routine. RDN/UDN intact per routine. CR < 2s. No gross deformity. Compartments soft.	
ABD [[Right Lower Quadrant (RLQ) Pain]]	
Soft, NTND, no rigidity, no rebound, no guarding, Neg. Obturator's Sign, Neg. Psoas Sign.	
ABD [[Right Upper Quadrant Pain]]	
Soft, NTND, no rigidity, no rebound, no guarding. Neg Murphy's Sign.	
Back Exam	
Patient can stand on tiptoes, dorsiflex bilaterally, rise bigtes b/l, and can can squat	
[[Straight Leg Test]] ***	
[[Compartment Syndrome]]	
Compartments soft , no pain in compartments on passive stretch, no pallor, warm, + distal pulses, + active movement in ***	
DFE (Fundoscopic)	
R (Retina): Sharp Disc Margins	
M (macula)	
V (vessels)	
P (periphery)	
D (disk)	
[[Eye Exam]]	
VF ([[Visual Field(s)]]): Intact by 4	
VA (Visual Acuity): 20/20 w/ PH	
EOM ([[Extraocular Muscle]]s):	
Intact w/o diplopia	
IOP: 20	
GU Male	
Testicular exam with normal lie and CMR bilaterally, no significant erythema, tenderness or swelling appreciated. No appreciable [[Inguinal Hernia]] bilaterally. No rashes or lesions. No penile discharge. No blood at meatus.	
Head Trauma	
No [[Septal hematoma]], TM x2 clear w/o e/o hemotypanum or CSF rhinorrhea, no [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], [[Raccoon eyes]] or csf rhinorrhea, no e/o entrapment, no diplopia on EOM, PERRL, EOMI. No facial tenderness over zygoma, mandible or maxilla. TMJ intact. Midface stable. Nose midline without significant deviation. No ML C-spine TTP.	
Knee Exam	
Full range of motion of right ankle, right knee without pain, (-) right [[Patellar]] tenderness. Negative mcburney's, negative Lachman's, [[Posterior Drawer Test]]. 5/5 strength of ankle, knee and hip with stable gait. No effusion appreciated.	
Neuro Exam	
CN2-12 intact b/l. EOMI. 5/5 strength in UE and LE. Intact sensation b/l. No dysmetria, no dysdokinesia. Neg protanator drift, neg romberg. Gait nl.	
Pelvic Exam Female	
Pelvic Exam: Closed Os, *purulent mucopurulent cervical exudate. *cervix Frability, *cervical erythema, edema. *Adnexal Tenderness, *CMT. *[[Vaginal Vault]] Discharge	
Rectal Exam	
RECTAL EXAM: no fissures, no [[Hemorrhoid (Pile)]], +brown stool, no [[Melena (Dark Tarry Stool)]], no bright red blood.	
SLE	
EXT (external structures): normal	
LLL (lids lashes and [[Lacrimation]]): No lesions	
CS (conjunctiva and sclera): White And Quiet	
K (cornea): No Fluorescein Uptake	
AC ([[Anterior Chamber]]): Deep and Quiet	
I (iris): Round and Reactive	
L (lens): Clear	
V (vitreous)	
[[Shoulder Exam]]	
No tenderness to shoulder, no limited flexion and abduction of shoulder secondary to pain, rotator cuff tests are negative. Able to touch opposite shoulder with hand. No deformities. Radian, medial, and ulnar nerves intact to motor and sensation. Good distal pulses and good cap refill	
PEAllergicDermatitis	
(+) blanching [[Nontender]] mildly pruritic maculopapular centrally confluent rash with satellite lesions over _. Negative nikolsky’s. No perineal, scrotal or mucosal involvement_. No discharge or crusting.	
PEAnkle	
NVI per routine with appropriate cap refill, extension and flexion of digits, sensation intact to FT throughout	
No pain over 1st and 5th MTP	
No medial or lateral malleolar tenderness	
No proximal tib/fib pain	
PEApicalAbscess	
(+) small _ cm abscess over interdental papilla of right lower premolar_ between teeth 29 and 30_ with mild gingival thickening, otherwise gingival tissues pink and stipple and firm. No discharge, no blood visualized.	
Otherwise, patient with no exudate to bilateral tonsillar beds and no erythema to upper palate or tonsillar beds. No uvular deviation. Full range of motion of neck. No evidence of overt RPA or PTA on exam. Non-elevated [[Tongue]] with soft lower palate. No [[Carotid Artery Bruit]] heard in neck. No petechiae around face or neck. No LAD appreciated. Supple.	
PECTLS	
No TTP over C/T/L/S midline	
PEGUMale	
Testicular exam with normal lie and CMR bilaterally, no significant erythema, tenderness or swelling appreciated. No appreciable [[Inguinal Hernia]] bilaterally. No rashes or lesions. No penile discharge. No blood at meatus.	
PEGeneral	
Comfortably resting, lying in bed, NAD, non[[Sweating]], lucid, fully conversant, no [[Respiratory Distress]], alert and oriented.	
PEHand	
2+ RP symmetric bilaterally. CR < 2 seconds bilaterally. Neurovascularly intact to radian, median, ulnar per routine to both fine touch and motor in distal hands.	
Right hand:	
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.	
Left hand:	
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.	
PEHeadTrauma	
No [[Septal hematoma]], TM x2 clear w/o e/o hemotypanum or CSF rhinorrhea, no [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], [[Raccoon eyes]] or csf rhinorrhea, no e/o entrapment, no diplopia on EOM, PERRL, EOMI. No facial tenderness over zygoma, mandible or maxilla. No malocclusion or [[Tetanus (Tetany; Trismus; Lockjaw)]]. TMJ grossly intact. Midface stable. Nose midline without significant deviation. No ML C-spine TTP.	
PEKnee	
Full range of motion of right ankle, right knee without pain, (-) right [[Patellar]] tenderness. Negative mcburney’s, negative Lachman’s, [[Posterior Drawer Test]]. 5/5 strength of ankle, knee and hip with stable gait. No effusion appreciated.	
PELowerExtremity	
No [[Lower Extremity Edema]], asymmetry, erythema or pain. 2+ DP.	
PENeuroExam	
Mental status: oriented, alert, lucid, cooperative, appropriate.	
Cranial nerves: [[CN 2 (Cranial Nerve (Two; II); Optic)]]-12 intact	
Motor: 5+ UE and LE, flexors and extensors symmetric.	
Sensation: Grossly intact to fine touch UE and LE symmetrically.	
Cerebellar: normal FTN bilaterally. No tremor noted.	
Gait: normal gait	
Tone: normal bulk and tone in upper and lower extremities. No atrophy noted.	
PEOpthoExam	
Visual Acuity:	
OD: 20/20	
OS: 20/20	
OU: 20/20	
No pinhole, no lens	
Pupils:	
OD: 4à2	
OS: 4à2	
APD: none	
[[IOP (Intraocular Pressure; 10–20 mmHg)]] –	
Tp OD: 15	
Tp OS: 15	
Extraocular motility: FULL OU	
Confrontational fields: intact in all fields OU.	
[[Slit Lamp]] exam:	
Lids and lashes: No edema and no periorbital erythema	
Conjunctiva and Sclera: no injection OU	
Cornea: no stromal edema, no ED OU	
[[Anterior Chamber]]: no cell, no flare OU	
Iris: round and reactive OU	
Lens: IOL OU	
PEPEDSGEN	
At baseline, well appearing, smiling, interactive, playing with mother. Nontoxic appearing. No tripoding, no drooling. Verbalization at baseline.	
PEPULM	
No overt [[Respiratory Distress]]. No tripoding or [[Accessory Muscle Use]]. No cyanosis. No clubbing. No stridor or audible [[Wheez(-e -es; -ing)]]. No visualizable [[Foreign Body]] or mass in [[Upper Airway]].	
PEPelvic	
Pelvic Exam: Closed Os, no purulent mucopurulent cervical exudate. no cervical friability, no cervical erythema, edema. No Adnexal Tenderness, no CMT. No [[Vaginal Vault]] Discharge or lacerations.	
PERashGen	
Diffuse nonconfluent pinpoint erythematous blanching [[Papular Rash]] predominately over thorax, extremities_. Pruritic, [[Nontender]], non discharge, some with overlying excoriations without evidence of cellulitis or superinfection. No tenderness to palpation. Negative nikolsky’s. No predominance over flexor creases. No involvement of nails or web spaces of hands.	
PESepticJoint	
Full range of motion of left ankle_, (+) _ [[Patellar]] tenderness. 5/5 strength of left ankle, knee and hip but limited by pain. Possible small knee effusion on ballotment_. Mild erythema over anterior superior knee _. No pain [[Out of proportion]]; area traced out and observed throughout ED stay without extension. No pain on axial loading. Passive and active ROM to 120 degrees without significant discomfort. + TTP over area of erythema w/o fluctuance. 2+ DP.	
PEShoulder	
No tenderness to shoulder, no limited flexion and abduction of shoulder secondary to pain, rotator cuff tests are negative. Able to touch opposite shoulder with hand. No deformities. Radian, medial, and ulnar nerves intact to motor and sensation. Good distal pulses and good cap refill.	
There is no bruising and no laceration of the skin. The clavicle is not elevated, and the skin is not tented. No sulcus sign when palpating the [[Humeral Head]] and scapula. No scapular tenderness. He has intact [[Axillary Nerve]] sensation. He has no pain or limitation to ROM of elbow, or wrist. He has intact motor distal but limited ROM of the shoulder due to pain.	
PEThroat	
Patient with no exudate to bilateral tonsillar beds and no erythema to upper palate or tonsillar beds. No uvula deviation. Full range of motion of neck. No evidence of overt RPA or PTA on exam. Non-elevated [[Tongue]] with soft lower palate. No [[Tetanus (Tetany; Trismus; Lockjaw)]]. No [[Carotid Artery Bruit]] heard in neck. No petechiae around face or neck. No LAD appreciated. FROM, supple.	
DC	
DC[[Numbness]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Numbness]] in your _. Your evaluation, including labs and imaging_, suggests that your symptoms are due to __.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for palpitations. Your evaluation suggests _.	
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for persistent periods of very rapid heart rate that is associated with [[SOB (Shortness of Breath)]], worsening fatigue with trouble exercising, chest pain, [[Dizziness]], [[Fainting]], or for any other concerning symptoms.	
DCPEDSAbdominalPain	
Your child has been evaluated in the Olive View-UCLA Emergency Department today. Their evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of the current condition.	
Please follow up with your pediatrician within one to two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department immediately if your child has worsening [[Abdominal Pain]], persistent fevers of 100.4°F or greater, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], or any other concerning symptoms.	
DCPEDSURI	
Your child was evaluated in the Olive View-UCLA Emergency Department today for cough. Their [[PE (Physical Exam(ination))]] suggests that their symptoms are likely due to a viral illness. Viral illnesses should resolve on their own over time. You should give tylenol or motrin as needed using the directions provided to you and give plenty of fluids.	
Please follow up with their pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if XXXX experiences worsening cough, trouble breathing, fever, recurrent vomiting, [[Lethargy]], or any other concerning symptoms.	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a fever. Their evaluation suggests that the symptoms are likely due to a viral illness_. Viral illnesses should resolve on their own_.	
Please alternate Tylenol and Motrin every 4-6 hours to help control fever and give plenty of fluids.	
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department immediately if your child experiences persistent fevers greater than 100.4°F that cannot be controlled with Tylenol/Motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], difficulty breathing, or any other concerning symptoms.	
Your child has been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your child’s evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your child was observed in the ED without any evidence of neurological instability.	
Please follow up with your child’s pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences worsening headaches, vision changes, recurrent vomiting, difficulty with normal activities, [[Lethargy]], abnormal behavior, difficulty walking, weakness, persistent fevers, or any other concerning symptoms.	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a laceration. Their laceration was closed with sutures in the Emergency Department. Please keep the area surrounding the laceration clean and dry. To minimize scarring reduce sun exposure for the next year by wearing sunscreen, hats and long clothing.	
Please follow up with your pediatrician within two days for a wound check. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences discharge from the laceration, redness around the laceration, warmth around the laceration, persistent fevers, recurrent vomiting, or any other concerning symptoms.	
Your child has been evaluated in the Olive View-UCLA Emergency Department today for _ pain. Their evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable_.	
Please rest, ice, and elevate to control pain and inflammation. Please give your child tylenol/motrin as directed in the attached dosing instructions for discomfort.	
Please follow up with your Pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Please follow up with a pediatric orthopedic surgeon in about 1 week. You can find a pediatric by follow up with a pediatrician.	
Return to the Emergency Department if your child experiences worsening pain, change of color in their _, persistent fevers, recurrent vomiting, or any other concerning symptoms.	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a rash. Their evaluation suggests _.	
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences difficulty breathing or swallowing, lip/mouth/[[Tongue]] swelling, persistent fevers >100.4 that cannot be controlled with tylenol/motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], discharge from his rash, or any other concerning symptoms.	
You were examined in the Olive View-UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that _.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with your primary care doctor for an appointment with a urologist. Call (818) 364-3129 if you were not given an appointment time over the phone with an Olive View-UCLA urologist.	
Return to the Emergency Department immediately if you experience worsening penile pain, increasing redness or discharge from the penis, fevers or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff_ and have been cleared to go home.	
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.	
Psychiatric Urgent Care	
14659 Olive View Dr.	
Sylmar, CA 91342	
(818) 485-0888	
HRS M-F 8am-10pm Sat-Sun 9am-5:30pm	
Return to the Emergency Department immediately if you experience thoughts of hurting yourself or others, audio or [[Visual Hallucinations]], or for any other concerning symptoms.	
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a kidney infection ([[Pyelonephritis]]). Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
DCSeizure	
You have been evaluated in the Olive View-UCLA Emergency Department today for a seizure. Your evaluation, including labs and CT of your brain, were unremarkable_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Follow up with your primary care doctor to make an appointment with a neurologist. If you were referred to a neurologic here at Olive View-UCLA, please follow up with that appointment which you will be called for.	
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
DC INST – ALCOHOL INTOXICATION	
DC	
You have been evaluated in the Emergency Department today for alcohol intoxication. You have been observed in the Emergency Department and are now able to walk on your own and are tolerating fluids/food.	
Please follow up with your primary care physician.	
Return to the Emergency Department if you experience shaking, [[Seizure]], palpitations, inability to keep down fluids, worsening or uncontrolled pain, confusion, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged alcohol, discharge, ETOH, tox Leave a comment	
DC INST – ALCOHOL INTOXICATION	
DC	
You have been evaluated in the Emergency Department today for alcohol intoxication. You have been observed in the Emergency Department and are now able to walk on your own and are tolerating fluids/food.	
Please follow up with your primary care physician.	
Return to the Emergency Department if you experience shaking, [[Seizure]], palpitations, inability to keep down fluids, worsening or uncontrolled pain, confusion, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged alcohol, discharge, ETOH, tox Leave a comment	
DC INST – EPISTAXIS	
DC	
You have been evaluated in the Emergency Department today for your [[Nose Bleed (Epistaxis)]]. Your bleeding was controlled in the ER with pressure. Your bleeding was most likely caused by dry and fragile skin inside your nose.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening or uncontrolled bleeding, [[SOB (Shortness of Breath)]], feeling lightheaded or dizzy, [[LOC (Loss (Of) Consciousness)]], [[Fainting]], nausea or vomiting, chest pain, or for any other concerning symptoms.	
Thank you for choosing usfor your care.	
DC INST – FRACTURE GENERIC	
DC	
You have been evaluated in the Emergency Department today for * pain. Your evaluation showed a fracture of your *. We have placed your *** in a splint today, avoid getting the splint wet.	
Please rest, ice, and elevate your * to help it heal. *We have provided crutches for you to use at home while your *** heals.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. *** Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.	
Please follow-up with an orthopedic surgeon in 1 week.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]], tingling, change of color in your ***, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, fracture, msk, ortho Leave a comment	
DC INST – FRACTURE GENERIC	
DC	
You have been evaluated in the Emergency Department today for * pain. Your evaluation showed a fracture of your *. We have placed your *** in a splint today, avoid getting the splint wet.	
Please rest, ice, and elevate your * to help it heal. *We have provided crutches for you to use at home while your *** heals.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. *** Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.	
Please follow-up with an orthopedic surgeon in 1 week.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]], tingling, change of color in your ***, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, fracture, msk, ortho Leave a comment	
DC INST – G TUBE REPLACEMENT	
DC	
You have been evaluated in the Emergency Department today for a problem with your G-tube. Your G-tube was replaced in the ER and you had imaging to confirm placement.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience fevers, vomiting, redness, swelling, or discharge from the G-tube site, if your G-tube falls out, if you are unable to use the G-tube, for pain with using the G-tube, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, g-tube, gastric tube, gi Leave a comment	
DC INST – G TUBE REPLACEMENT	
DC	
You have been evaluated in the Emergency Department today for a problem with your G-tube. Your G-tube was replaced in the ER and you had imaging to confirm placement.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience fevers, vomiting, redness, swelling, or discharge from the G-tube site, if your G-tube falls out, if you are unable to use the G-tube, for pain with using the G-tube, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, g-tube, gastric tube, gi Leave a comment	
DC INST – [[Gastritis]]	
DC	
You were evaluated in the Emergency Department today for [[Epigastric (Abdominal) Pain]], which is most likely due to irritation of the lining of your stomach. Your symptoms improved with medication in the ED. You can take Mylanta, which is available over the counter, to help manage your symptoms. Avoid spicy or acidic foods.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience [[SOB (Shortness of Breath)]], worsening or uncontrolled abdominal or chest pain, headache, light headedness, feeling faint, nausea, vomiting, bloody vomit or stools, [[Black Tarry Stool]]s, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, [[Gastritis]], gi Leave a comment	
DC INST – [[Gastroenteritis]]	
DC	
You have been evaluated in the Emergency Department today for [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to viral illness which will improve on its own with rest and fluids. Remember to drink plenty of fluids at home.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, [[Gastroenteritis]], gi, nausea, vomiting Leave a comment	
DC INST – HEAD INJURY (CT)	
DC	
You have been evaluated in the Emergency Department today for your head injury. Your CT scan did not show signs of bleeds or fractures in your head.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please schedule an appointment for follow up with your primary care physician as soon as possible.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged closed head injury, CT, discharge, neuro Leave a comment	
DC INST – HEAD INJURY (CT)	
DC	
You have been evaluated in the Emergency Department today for your head injury. Your CT scan did not show signs of bleeds or fractures in your head.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please schedule an appointment for follow up with your primary care physician as soon as possible.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged closed head injury, CT, discharge, neuro Leave a comment	
DC INST – HEADACHE	
DC	
You have been evaluated in the Emergency Department today for headache. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time, and your pain improved with medication in the ED.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, headache, neuro Leave a comment	
DC INST – [[Hemorrhoid (Pile)]]	
DC	
You have been evaluated in the Emergency Department today for your [[Rectal Pain]]. Your evaluation has revealed that your symptoms are due to [[Hemorrhoid (Pile)]]. You can apply [[Phenylephrine (Hemorrhoid (Piles)) Cream (PREPARATION H)]], which is available over the counter, and do [[Sitz Bath]]s to soothe the area. Stay well hydrated, eat a [[High Fiber (Diet; Intake)]], and take stool softeners- you should not strain on the toilet.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening bleeding, feel lightheaded, have [[SOB (Shortness of Breath)]], have headache, feel weak, have fever, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, gi, [[Hemorrhoid (Pile)]] Leave a comment	
DC INST – KNEE PAIN	
DC	
You were evaluated in the Emergency Department today for your knee pain. Your evaluation, including ***X-rays of your knee, did not show signs of fractures or other acute abnormalities which require further intervention at this time.	
Your knee has been ace wrapped and you were given crutches in the ER to help your knee heal. Please rest, ice and elevate your knee, and resume normal activities as tolerated.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. ***Please take your prescribed norco as directed as necessary for pain. Do not drive or take medications containing tylenol while taking norco.	
Please follow up with your primary care physician within three days.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]], tingling, or weakness to your legs, difficulty walking, worsening knee swelling or redness, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, knee pain, msk, ortho Leave a comment	
DC INST – KNEE PAIN	
DC	
You were evaluated in the Emergency Department today for your knee pain. Your evaluation, including ***X-rays of your knee, did not show signs of fractures or other acute abnormalities which require further intervention at this time.	
Your knee has been ace wrapped and you were given crutches in the ER to help your knee heal. Please rest, ice and elevate your knee, and resume normal activities as tolerated.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. ***Please take your prescribed norco as directed as necessary for pain. Do not drive or take medications containing tylenol while taking norco.	
Please follow up with your primary care physician within three days.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]], tingling, or weakness to your legs, difficulty walking, worsening knee swelling or redness, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, knee pain, msk, ortho Leave a comment	
DC INST – LAC REPAIR	
DC	
You have been evaluated in the Emergency Department today for a laceration to your ***. Your laceration was repaired in the ED with sutures. Please keep the area surrounding the laceration clean and dry. Please keep the area out of the sunlight for the next 6 months to help prevent scarring. You should have the sutures removed in 7-10 days by your primary care physician, or at your local urgent care or ER. If you develop redness or swelling at the site of your laceration please come back to the ER for a wound check.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please follow up with your primary care physician in 7-10 days for suture removal. You can also return to the ER or another urgent care facility for this service.	
Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, [[Numbness]], tingling, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged derm, discharge, laceration, msk, ortho Leave a comment	
DC INST – LAC REPAIR	
DC	
You have been evaluated in the Emergency Department today for a laceration to your ***. Your laceration was repaired in the ED with sutures. Please keep the area surrounding the laceration clean and dry. Please keep the area out of the sunlight for the next 6 months to help prevent scarring. You should have the sutures removed in 7-10 days by your primary care physician, or at your local urgent care or ER. If you develop redness or swelling at the site of your laceration please come back to the ER for a wound check.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please follow up with your primary care physician in 7-10 days for suture removal. You can also return to the ER or another urgent care facility for this service.	
Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, [[Numbness]], tingling, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged derm, discharge, laceration, msk, ortho Leave a comment	
DC INST – MENSTRUAL CRAMPS	
DC	
You have been evaluated in the Emergency Department today for your cramping [[Abdominal Pain]]. Your evaluation suggests that your symptoms are due to menstrual cramps.	
Please take [[Ibuprofen; ((ADVIL), (MOTRIN))]] up to 600mg every 6 hours to control pain. You can also use heating or cooling packs.	
Please follow up with your primary care physician within 1 week. You can find a primary care doctor at UCLA by calling 310-825-2631. You can call (310) 794-7274 to schedule an appointment with a UCLA OB/Gyn.	
Return to the Emergency Department if you experience [[Vaginal Bleeding]], [[SOB (Shortness of Breath)]], feeling lightheaded, chest [[Tightness]], worsening or uncontrolled pain, fevers 100.4°F or greater, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Leave a comment	
DC INST – MENSTRUAL CRAMPS	
DC	
You have been evaluated in the Emergency Department today for your cramping [[Abdominal Pain]]. Your evaluation suggests that your symptoms are due to menstrual cramps.	
Please take [[Ibuprofen; ((ADVIL), (MOTRIN))]] up to 600mg every 6 hours to control pain. You can also use heating or cooling packs.	
Please follow up with your primary care physician within 1 week. You can find a primary care doctor at UCLA by calling 310-825-2631. You can call (310) 794-7274 to schedule an appointment with a UCLA OB/Gyn.	
Return to the Emergency Department if you experience [[Vaginal Bleeding]], [[SOB (Shortness of Breath)]], feeling lightheaded, [[Chest Tightness]], worsening or uncontrolled pain, fevers 100.4°F or greater, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Leave a comment	
DC INST – MSK PAIN	
DC	
You have been evaluated in the Emergency Department today for *** pain. Your evaluation did not find evidence of medical conditions requiring emergent intervention at this time.	
We have provided crutches for you to use while your * heals. Please rest, ice, and elevate your *, and resume normal activities as tolerated.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please schedule an appointment for follow up with your primary care physician this week.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]], tingling, change of color in your toes, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged discharge, msk, [[MSK (Musculoskeletal)]], ortho Leave a comment	
DC INST – MSK PAIN	
DC	
You have been evaluated in the Emergency Department today for *** pain. Your evaluation did not find evidence of medical conditions requiring emergent intervention at this time.	
We have provided crutches for you to use while your * heals. Please rest, ice, and elevate your *, and resume normal activities as tolerated.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please schedule an appointment for follow up with your primary care physician this week.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]], tingling, change of color in your toes, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged discharge, msk, [[[MSK (Musculoskeletal)]]](https://natedotphrase.com/tag/[[MSK (Musculoskeletal)]]/), ortho Leave a comment	
DC INST – MUSCLE STRAIN	
DC	
You have been evaluated in the Emergency Department today for your  pain after ___. Your pain is most likely muscle strain which will improve on its own.	
Please follow up with your primary care physician in 2-3 days.	
Please rest, ice, and elevate your  to control pain and inflammation.	
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your , color change to your , or for any other concerning symptoms.	
Thank you for choosing us for your care	
April 12, 2018 Tagged discharge, msk, muscle strain, ortho Leave a comment	
DC INST – MUSCLE STRAIN	
DC	
You have been evaluated in the Emergency Department today for your  pain after ___. Your pain is most likely muscle strain which will improve on its own.	
Please follow up with your primary care physician in 2-3 days.	
Please rest, ice, and elevate your  to control pain and inflammation.	
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your , color change to your , or for any other concerning symptoms.	
Thank you for choosing us for your care	
April 12, 2018 Tagged discharge, msk, muscle strain, ortho Leave a comment	
DC INST – MVC	
DC	
You have been evaluated in the Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
***Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.	
Please follow up with your primary care physician in 2-3 days.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged discharge, mva, mvc Leave a comment	
DC INST – NOSE INJURY	
DC	
You have been evaluated in the Emergency Department today for your nose injury after a fall. Your nose does not appear to be fractured.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please follow up with your primary care physician in 2-3 days. If your nose appears to be deformed in 3-4 days, you can find a plastic surgeon by calling (310) 825-5510 or an Ear, Nose, and Throat physician by calling 310-206-6688.	
Return to the ER immediately for vomiting, confusion, worsening or uncontrolled pain, difficulty breathing, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged discharge, ent, face, nasal fracture Leave a comment	
DC INST – NOSE INJURY	
DC	
You have been evaluated in the Emergency Department today for your nose injury after a fall. Your nose does not appear to be fractured.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please follow up with your primary care physician in 2-3 days. If your nose appears to be deformed in 3-4 days, you can find a plastic surgeon by calling (310) 825-5510 or an Ear, Nose, and Throat physician by calling 310-206-6688.	
Return to the ER immediately for vomiting, confusion, worsening or uncontrolled pain, difficulty breathing, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged discharge, ent, face, nasal fracture Leave a comment	
DC INST – PENILE PAIN	
DC	
You were examined in the UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that XXXX.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department immediately if you experience worsening penile pain, increasing discharge or redness from the penis, fevers or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged discharge, gu, penile Leave a comment	
DC INST – PENILE PAIN	
DC	
You were examined in the UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that XXXX.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department immediately if you experience worsening penile pain, increasing discharge or redness from the penis, fevers or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged discharge, gu, penile Leave a comment	
DC INST – [[Peritonsillar Abscess]]	
DC	
You have been evaluated in the Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation has revealed an early, small [[Peritonsillar Abscess]]. Your abscess was incised and drained in the Emergency Department.	
Please take your prescribed antibiotics for the full course of the medication.	
Please follow up with a Head and Neck doctor in about 1 week.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty swallowing, eating, or breathing, pain on moving your jaw, [[Tongue]] swelling, fevers 100.4°F or greater, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged abscess, discharge, ent, PTA, throat Leave a comment	
DC INST – PERITONSILLAR ABSCESS	
DC	
You have been evaluated in the Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation has revealed an early, small [[Peritonsillar Abscess]]. Your abscess was incised and drained in the Emergency Department.	
Please take your prescribed antibiotics for the full course of the medication.	
Please follow up with a Head and Neck doctor in about 1 week.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty swallowing, eating, or breathing, pain on moving your jaw, [[Tongue]] swelling, fevers 100.4°F or greater, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
DC INST – PSYCH	
DC	
You have been evaluated in the Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff and have been cleared to go home.	
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.	
Return to the Emergency Department if you experience thoughts of hurting yourself or others, audio or visual [[Hallucinations]], or for any other concerning symptoms.	
April 16, 2018 Tagged DC, psych Leave a comment	
DC INST – RASH	
DC	
You were evaluated in the Emergency Department today for a rash. Your evaluation suggests your symptoms are most likely due to ***.	
Please follow up with your primary care physician within 2-3 days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.	
Return to the Emergency Department if you experience worsening or spreading rash, worsening or uncontrolled pain, fevers 100.4°F or greater, recurrent vomiting, [[SOB (Shortness of Breath)]], discharge from your rash, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, derm, rash Leave a comment	
DC INST – [[Renal Colic]]	
DC	
You have been evaluated in the Emergency Department today for your flank pain. Your pain is most likely due to a kidney stone which will pass on its own.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening pain, fever, painful urination, [[Blood In Urine]], weakness, chest pain, difficulty breathing or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, [[Nephrolithiasis ((Kidney; Renal) Stone(s))]], renal Leave a comment	
DC INST – RENAL COLIC	
DC	
You have been evaluated in the Emergency Department today for your flank pain. Your pain is most likely due to a [[Nephrolithiasis ((Kidney; Renal) Stone(s))]] which will pass on its own.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening pain, fever, painful urination, [[Blood In Urine]], weakness, chest pain, difficulty breathing or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, [[Nephrolithiasis ((Kidney; Renal) Stone(s))]]](https://natedotphrase.com/tag/[[Nephrolithiasis ((Kidney; Renal) Stone(s))]]/), renal Leave a comment	
DC INST – SEIZURE	
DC	
You have been evaluated in the Emergency Department today for a seizure. Your evaluation, including labs and a CT of your brain, were unremarkable. Do not drive until you are cleared by a physician.	
Please follow up with your primary care physician within two days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.	
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, neuro, seizure Leave a comment	
DC INST – [[SOB (Shortness of Breath)]]	
DC	
You were evaluated in the Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Steroid]], and your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. ***You have been given a prescription for [[Steroid]], please take them as directed.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, headache, light headedness, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, [[Dyspnea]], pulm, SOB Leave a comment	
DC INST – SHORTNESS OF BREATH	
DC	
You were evaluated in the Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Steroid]], and your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. ***You have been given a prescription for [[Steroid]], please take them as directed.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, headache, light headedness, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, [[Dyspnea]]](https://natedotphrase.com/tag/[[Dyspnea]]/), pulm, SOB Leave a comment	
DC INST – SHOULDER DISLOCATION	
DC	
You have been evaluated in the Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, revealed a shoulder dislocation. We have reduced your shoulder, please use the sling for comfort.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. ***Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.	
Please follow up with your primary care physician within two days.	
Please follow up with an orthopedic surgeon in 1 week.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your fingers, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, dislocation, ortho, shoulder Leave a comment	
DC INST – SHOULDER DISLOCATION	
DC	
You have been evaluated in the Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, revealed a shoulder dislocation. We have reduced your shoulder, please use the sling for comfort.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. ***Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.	
Please follow up with your primary care physician within two days.	
Please follow up with an orthopedic surgeon in 1 week.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your fingers, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, dislocation, ortho, shoulder Leave a comment	
DC INST – [[Sore Throat (Pharyngitis)]]	
DC	
You have been evaluated in the Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests your symptoms are due to ***.	
***Please take your prescribed antibiotics as directed for the full course of the medication.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, change in your voice, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, [[Sore Throat (Pharyngitis)]], sore throat Leave a comment	
DC INST – SORE THROAT	
DC	
You have been evaluated in the Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests your symptoms are due to ***.	
***Please take your prescribed antibiotics as directed for the full course of the medication.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, change in your voice, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, pharyngitis, [[Sore Throat (Pharyngitis)]]](https://natedotphrase.com/tag/sore-throat/) Leave a comment	
DC INST – STI	
DC	
You have been evaluated in the Emergency Department today for your ***. You were tested today for [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] and the results are still pending; you have been given treatment for these infections presumptively anyway. You will receive a phone call in~3 days if the results are positive. You should follow up with your primary care provider for further STI testing.	
***Please take your prescribed antibiotics for the full course of the medication as directed.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged antibiotics, DC, gu, sti Leave a comment	
DC INST – SUTURE REMOVAL	
DC	
You have been evaluated in the Emergency Department today for suture removal. Your sutures were removed and your wound is healing well. You can wash the area freely now. Keep your wound out of the sunlight for six months to reduce the appearance of scarring. You should cover your scar or use high SPF sunscreen protection.	
Please follow up with your primary care doctor at your next scheduled appointment.	
Return to the ER immediately signs of infection to your wounds such as worsening pain, worsening redness/swelling, discharge/pus from your wounds, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, suture removal Leave a comment	
DC INST – SUTURE REMOVAL	
DC	
You have been evaluated in the Emergency Department today for suture removal. Your sutures were removed and your wound is healing well. You can wash the area freely now. Keep your wound out of the sunlight for six months to reduce the appearance of scarring. You should cover your scar or use high SPF sunscreen protection.	
Please follow up with your primary care doctor at your next scheduled appointment.	
Return to the ER immediately signs of infection to your wounds such as worsening pain, worsening redness/swelling, discharge/pus from your wounds, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, suture removal Leave a comment	
DC INST – UPPER RESPIRATORY	
DC	
You were evaluated in the Emergency Department today for your congestion, cough and fevers. Your evaluation suggests that your symptoms are most likely due to a viral illness, which will improve on its own with rest and fluids.	
***We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for fever. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please schedule an appointment for follow up with your primary care physician this week.	
Return to the Emergency Department if you experience worsening cough, fever 100.4 ° F or greater not controlled by Tylenol or [[Ibuprofen; ((ADVIL), (MOTRIN))]], recurrent vomiting, chest pain, [[SOB (Shortness of Breath)]], or any other concerning symptoms.	
Thank you for choosing UCLA for your care.	
April 16, 2018 Tagged cough, DC, pulm Leave a comment	
DC INST – UPPER RESPIRATORY	
DC	
You were evaluated in the Emergency Department today for your congestion, cough and fevers. Your evaluation suggests that your symptoms are most likely due to a viral illness, which will improve on its own with rest and fluids.	
***We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for fever. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please schedule an appointment for follow up with your primary care physician this week.	
Return to the Emergency Department if you experience worsening cough, fever 100.4 ° F or greater not controlled by Tylenol or [[Ibuprofen; ((ADVIL), (MOTRIN))]], recurrent vomiting, chest pain, [[SOB (Shortness of Breath)]], or any other concerning symptoms.	
Thank you for choosing UCLA for your care.	
April 16, 2018 Tagged cough, DC, pulm Leave a comment	
DC INST – UTI	
DC	
You have been evaluated in the Emergency Department today for your urinary symptoms. Your evaluation, including urinalysis, suggests that your symptoms are due to a [[UTI (Urinary Tract Infection)]]. Please take your prescribed antibiotics for the full course of the medication as directed.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, vomiting, flank pain, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged antibiotics, DC, urinary tract, uti Leave a comment	
DC INST – [[Vaginal Bleeding]]	
DC	
You have been evaluated in the UCLA Emergency Department today for your [[Vaginal Bleeding]]. Your evaluation suggests that your symptoms are due to *. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] showed *.	
Please follow up with your primary care physician within two days.	
***Please follow up with your OB/Gyn within 2 days.	
Return to the Emergency Department if you experience worsening or uncontrolled bleeding, [[SOB (Shortness of Breath)]], feeling lightheaded, [[Chest Tightness]], abdominal cramping, severe [[Abdominal Pain]], fevers,vomiting, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, gyn, [[Vaginal Bleeding]] Leave a comment	
DC INST – VAGINAL BLEEDING	
DC	
You have been evaluated in the UCLA Emergency Department today for your [[Vaginal Bleeding]]. Your evaluation suggests that your symptoms are due to *. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] showed *.	
Please follow up with your primary care physician within two days.	
***Please follow up with your OB/Gyn within 2 days.	
Return to the Emergency Department if you experience worsening or uncontrolled bleeding, [[SOB (Shortness of Breath)]], feeling lightheaded, [[Chest Tightness]], abdominal cramping, severe [[Abdominal Pain]], fevers,vomiting, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
__April 16, 2018 Tagged DC, gyn, [[Vaginal Bleeding]]	
DC INST – [[Vasovagal Syncope]]	
DC	
You have been evaluated in the Emergency Department today for your syncopal episode. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time, however we recommend you follow up with your primary care provider for further testing as an outpatient.	
Please follow up with your primary care doctor in 2-3 days.	
Return to the ER immediately for worsening or uncontrolled symptoms, headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, neuro, syncope Leave a comment	
DC INST – VASOVAGAL SYNCOPE	
DC	
You have been evaluated in the Emergency Department today for your syncopal episode. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time, however we recommend you follow up with your primary care provider for further testing as an outpatient.	
Please follow up with your primary care doctor in 2-3 days.	
Return to the ER immediately for worsening or uncontrolled symptoms, headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, neuro, syncope Leave a comment	
DC INST – VOMITING	
DC	
You have been evaluated in the Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely to do a viral infection which will improve on its own with rest and fluids.	
Please follow up with your primary care physician within two days.	
Remember to drink plenty of fluids at home.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
Thank you for choosing for your care.	
April 16, 2018 Tagged DC, gastro, vomiting Leave a comment	
DC INST – WRIST PAIN	
DC	
You have been evaluated in the Emergency Department today for wrist pain after a fall. Your evaluation, including [[PE (Physical Exam(ination))]] and x-ray, has revealed that you have a fracture of your ___ // no evidence of any acute fractures or dislocations.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package. Please also rest, ice, and elevate your arm to control pain and inflammation.	
Please follow up with your primary care physician within two days. If your pain persists in 7- 10 days please have repeat x-ray. // Please follow up with an orthopedic surgeon within 1 week.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, msk, wrist Leave a comment	
DC INST – WRIST PAIN	
DC	
You have been evaluated in the Emergency Department today for wrist pain after a fall. Your evaluation, including [[PE (Physical Exam(ination))]] and x-ray, has revealed that you have a fracture of your ___ // no evidence of any acute fractures or dislocations.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package. Please also rest, ice, and elevate your arm to control pain and inflammation.	
Please follow up with your primary care physician within two days. If your pain persists in 7- 10 days please have repeat x-ray. // Please follow up with an orthopedic surgeon within 1 week.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, msk, wrist Leave a comment	
DC INST – EPISTAXIS	
DC	
You have been evaluated in the Emergency Department today for your [[Nose Bleed (Epistaxis)]]. Your bleeding was controlled in the ER with pressure. Your bleeding was most likely caused by dry and fragile skin inside your nose.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening or uncontrolled bleeding, [[SOB (Shortness of Breath)]], feeling lightheaded or dizzy, [[LOC (Loss (Of) Consciousness)]], [[Fainting]], nausea or vomiting, chest pain, or for any other concerning symptoms.	
Thank you for choosing usfor your care.	
DC INST – [[Gastritis]]	
DC	
You were evaluated in the Emergency Department today for [[Epigastric (Abdominal) Pain]], which is most likely due to irritation of the lining of your stomach. Your symptoms improved with medication in the ED. You can take Mylanta, which is available over the counter, to help manage your symptoms. Avoid spicy or acidic foods.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience [[SOB (Shortness of Breath)]], worsening or uncontrolled abdominal or chest pain, headache, light headedness, feeling faint, nausea, vomiting, bloody vomit or stools, [[Black Tarry Stool]]s, or any other concerning symptoms.	
Thank you for choosing us for your care.	
[January 16, 2018](https://natedotphrase.com/2018/01/16/dc-inst-[[Gastritis]]/) Tagged discharge, [[[Gastritis]]](https://natedotphrase.com/tag/[[Gastritis]]/), gi [Leave a comment](https://natedotphrase.com/2018/01/16/dc-inst-[[Gastritis]]/#respond)	
DC INST – [[Gastroenteritis]]	
DC	
You have been evaluated in the Emergency Department today for [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to viral illness which will improve on its own with rest and fluids. Remember to drink plenty of fluids at home.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
Thank you for choosing us for your care.	
[January 16, 2018](https://natedotphrase.com/2018/01/16/dc-inst-[[Gastroenteritis]]/) Tagged discharge, [[[Gastroenteritis]]](https://natedotphrase.com/tag/[[Gastroenteritis]]/), gi, nausea, vomiting [Leave a comment](https://natedotphrase.com/2018/01/16/dc-inst-[[Gastroenteritis]]/#respond)	
DC INST – HEADACHE	
DC	
You have been evaluated in the Emergency Department today for headache. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time, and your pain improved with medication in the ED.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.	
Thank you for choosing us for your care.	
January 16, 2018 Tagged discharge, headache, neuro Leave a comment	
DC INST – [[Hemorrhoid (Pile)]]	
DC	
You have been evaluated in the Emergency Department today for your [[Rectal Pain]]. Your evaluation has revealed that your symptoms are due to [[Hemorrhoid (Pile)]]. You can apply [[Phenylephrine (Hemorrhoid (Piles)) Cream (PREPARATION H)]], which is available over the counter, and do [[Sitz Bath]]s to soothe the area. Stay well hydrated, eat a [[High Fiber (Diet; Intake)]], and take stool softeners- you should not strain on the toilet.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience worsening bleeding, feel lightheaded, have [[SOB (Shortness of Breath)]], have headache, feel weak, have fever, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
[January 16, 2018](https://natedotphrase.com/2018/01/16/dc-inst-[[Hemorrhoid (Pile)]]/) Tagged discharge, gi, [[[Hemorrhoid (Pile)]]](https://natedotphrase.com/tag/[[Hemorrhoid (Pile)]]/) [Leave a comment](https://natedotphrase.com/2018/01/16/dc-inst-[[Hemorrhoid (Pile)]]/#respond)	
DC INST – MVC	
DC	
You have been evaluated in the Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.	
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].	
***Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.	
Please follow up with your primary care physician in 2-3 days.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 12, 2018 Tagged discharge, mva, mvc Leave a comment	
DC INST – PSYCH	
DC	
You have been evaluated in the Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff and have been cleared to go home.	
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.	
Return to the Emergency Department if you experience thoughts of hurting yourself or others, audio or [[Visual Hallucinations]], or for any other concerning symptoms.	
April 16, 2018 Tagged DC, psych Leave a comment	
DC INST – RASH	
DC	
You were evaluated in the Emergency Department today for a rash. Your evaluation suggests your symptoms are most likely due to ***.	
Please follow up with your primary care physician within 2-3 days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.	
Return to the Emergency Department if you experience worsening or spreading rash, worsening or uncontrolled pain, fevers 100.4°F or greater, recurrent vomiting, [[SOB (Shortness of Breath)]], discharge from your rash, or any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, derm, rash Leave a comment	
DC INST – SEIZURE	
DC	
You have been evaluated in the Emergency Department today for a seizure. Your evaluation, including labs and a CT of your brain, were unremarkable. Do not drive until you are cleared by a physician.	
Please follow up with your primary care physician within two days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.	
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged DC, neuro, seizure Leave a comment	
DC INST – STI	
DC	
You have been evaluated in the Emergency Department today for your ***. You were tested today for [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] and the results are still pending; you have been given treatment for these infections presumptively anyway. You will receive a phone call in~3 days if the results are positive. You should follow up with your primary care provider for further STI testing.	
***Please take your prescribed antibiotics for the full course of the medication as directed.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged antibiotics, DC, gu, sti Leave a comment	
DC INST – UTI	
DC	
You have been evaluated in the Emergency Department today for your urinary symptoms. Your evaluation, including urinalysis, suggests that your symptoms are due to a [[UTI (Urinary Tract Infection)]]. Please take your prescribed antibiotics for the full course of the medication as directed.	
Please follow up with your primary care physician within two days.	
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, vomiting, flank pain, or for any other concerning symptoms.	
Thank you for choosing us for your care.	
April 16, 2018 Tagged antibiotics, DC, urinary tract, uti Leave a comment	
DC INST – VOMITING	
DC	
You have been evaluated in the Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely to do a viral infection which will improve on its own with rest and fluids.	
Please follow up with your primary care physician within two days.	
Remember to drink plenty of fluids at home.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
Thank you for choosing for your care.	
April 16, 2018 Tagged DC, gastro, vomiting Leave a comment	
DCAMA	
You have been evaluated in the Olive View-UCLA Emergency Department today. You are refusing further testing, imaging, and further admission and choosing to leave [[AMA (Against Medical Advice)]]. You were advised of your risks of leaving and understand that permanent harm, or even death, can occur from failing to follow the recommendations of the physician.	
Please follow up with your primary care physician within one day. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.	
Return to the Emergency Department immediately if you experience worsening or uncontrolled pain, persistent fevers, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], chest pain, [[SOB (Shortness of Breath)]], or for any other concerning symptoms.	
DCAbdPain	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Abdominal Pain]]. Your evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of your current condition.	
Return to the ER if your pain does not resolve within 8-12 hours or worsens. Please follow up with your primary care physician within one to two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], chest pain, difficulty breathing, or any other concerning symptoms.	
DCAbscessID	
You were evaluated in the Olive View-UCLA Emergency Department for an abscess. Your abscess was incised and drained in the Emergency Department. We have inserted a loose gauze in the abscess pocket to promote drainage and applied a clean dressing over it. You will need to change the dressing every 24 hours. Please keep the areas surrounding the abscess clean and dry. Take the antibiotics prescribed to you in full as directed.	
Follow up with your primary care physician within 2 days for a wound check. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, an increase in area of redness, increased tenderness/warmth around the abscess, [[Foul Smelling]] discharge from the abscess, or any other concerning symptoms.	
DCAbscessNoID	
You were evaluated in the Olive View-UCLA Emergency Department for an abscess. You should soak the area in warm water for 20-30 minutes 3-4 times daily. Contact your doctor when the abscess comes to a head and needs to be drained. Please keep the areas surrounding the abscess clean and dry. Take the antibiotics prescribed to you in full as directed.	
Follow up with your primary care physician within 2 days for a wound check. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, an increase in area of redness, increased tenderness/warmth around the abscess, [[Foul Smelling]] discharge from the abscess, or any other concerning symptoms.	
DCAllergicReaction	
You have been evaluated in the Olive View-UCLA Emergency Department today for your allergic reaction. You have been given medications including [[Steroid]], [[Epinephrine (Adrenaline)]], and [[Diphenhydramine (BENADRYL®)]] to control your swelling. You have been observed in the Emergency Department and it appears that your symptoms will not return.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience difficulty breathing or swallowing, recurrent vomiting, rashes, lip/mouth/[[Tongue]] swelling, persistent fevers or for any other concerning symptoms.	
Thank you for choosing Olive-ViewUCLA for your care.	
DCAnkle	
You have been evaluated in the Olive View-UCLA Emergency Department today for ankle pain. The x-ray of your ankle _.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your ankle to control your pain.	
Please follow up with your primary care physician within two days as needed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.	
DCAnxiety	
You have been evaluated in the Olive View-UCLA Emergency Department today for your anxiety. Your symptoms have resolved in the Emergency Department.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience new or worsening anxiety, depression, thoughts of harming yourself or others, or for any other concerning symptoms.	
DC[[Asthma]]	
You were evaluated in the Olive View-UCLA Emergency Department today for an acute exacerbation of your [[Asthma]]. Your symptoms improved receiving an albuterol breathing treatment.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms.	
DCBackPain	
You were evaluated in the Olive View-UCLA Emergency Department today for [[Back Pain (Dolor)]]. Your evaluation suggests no acute abnormalities which require further intervention at this time.	
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain. You should continue doing back exercises which could include going to [[Physical Therapy]].	
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening [[Back Pain (Dolor)]], incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.	
DCCellulitis	
You have been evaluated in the Olive View-UCLA Emergency Department today for a skin infection. Please take the prescribed antibiotics as directed for the full course of the medication.	
Follow up with your primary care physician within 2 days for a re-evaluation of the skin infection to make sure it has not spread and is getting better. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience an increase in area of redness, persistent fevers, increased tenderness/warmth around the skin infection, or any other concerning symptoms	
DCChestPain	
You have been evaluated in the Olive View-UCLA Emergency Department today for chest pain. Your evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your EKG did not show any acute changes.	
Please follow up with your primary care doctor in 2 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening chest pain, palpitations, [[SOB (Shortness of Breath)]], persistent vomiting, [[Fainting]], or for any other concerning symptoms.	
DCCough	
You were evaluated in the Olive View-UCLA Emergency Department today for a cough. Your evaluation suggests _.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening cough, fever, [[SOB (Shortness of Breath)]], recurrent vomiting, [[Lethargy]], or any other concerning symptoms.	
DCCystitis	
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed_.	
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
DCCystitis	
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed_.	
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
DCDentalPain	
You have been evaluated in the Olive View-UCLA Emergency Department today for your dental pain. Your pain has been controlled with __. Your [[PE (Physical Exam(ination))]] suggests no acute abnormalities which require further intervention at this time.	
Please follow up with your [[Dentist]] tomorrow. Call to schedule an appointment with a [[Dentist]]ry clinic.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, fevers 100.4°F or greater, vomiting, [[Tongue]] swelling, throat swelling, or any other concerning symptoms.	
DC[[Dizziness]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Dizziness]]. Your evaluation suggests _.	
You have been prescribed _ to help relieve your symptoms. Please take your prescription as directed.	
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, [[Fainting]], or for any other concerning symptoms	
DC[[Dysuria]]	
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take as directed in full_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
DCETOH	
You have been evaluated in the Olive View UCLA Emergency Department today for alcohol intoxication. You are now able to walk on your own and are tolerating fluids/food.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience inability to keep down fluids, worsening or uncontrolled pain, confusion, or for any other concerning symptoms.	
LA Country Drug Abuse and Prevention	
http://publichealth.lacounty.gov/sapc/findtreatment.htm	
Call: 800-564-6600	
DCEarPain	
You were evaluated in the Olive View-UCLA Emergency Department today for ear pain. Your [[PE (Physical Exam(ination))]] suggests that you have an ear infection_. Please take the antibiotics in full as directed_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience [[HL (Hearing Loss; Deafness)]], discharge from your ear, headaches, fevers, recurrent vomiting, or any other concerning symptoms.	
DCElbowPain	
You have been evaluated in the Olive View-UCLA Emergency Department today for elbow pain. Your evaluation, including physical exam and x-rays, were unremarkable// reveal a fracture_.	
Please use the sling for comfort_. You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with an orthopedic surgeon in about 1 week. If we referred you to the olive view specialists, please follow up with your appointment. Please call 818-364-3676 if you do not receive a call for an appointment time.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.	
DCEpistaxis	
You have been evaluated in the Olive View-UCLA Emergency Department today for a [[Nose Bleed (Epistaxis)]]. The bleeding was controlled in the Emergency Department and your examination reveals no active bleeding at this time.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately if you experience worsening bleeding, worsening or uncontrolled pain, difficulty breathing, or for any other concerning symptoms.	
DCEye	
You were evaluated in the Olive view-UCLA Emergency Department today for eye redness. Your [[PE (Physical Exam(ination))]] suggests _.	
Call (818)-364-3538 to schedule an appointment with the eye specialist within one week for a repeat [[Eye Exam]]._	
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience discharge from your eye, worsening eye redness, [[Eye Pain]], vision changes, headache, fever, vomiting, or any other concerning symptoms.	
DCFall	
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a mechanical fall. Your evaluation has revealed ___. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a fall before it gets better.	
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco only as needed for severe pain. Do not drive or operate heavy machinery while taking norco.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.	
DCFall	
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a mechanical fall. Your evaluation has revealed ___. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a fall before it gets better.	
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco only as needed for severe pain. Do not drive or operate heavy machinery while taking norco.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.	
DCFall	
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a mechanical fall. Your evaluation has revealed ___. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a fall before it gets better.	
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco only as needed for severe pain. Do not drive or operate heavy machinery while taking norco.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.	
DCFinger	
You have been evaluated in the Olive View-UCLA Emergency Department today for finger pain. Your evaluation, including physical exam and x-ray, has revealed that you have a fracture of your _// no evidence of any acute fractures or dislocations_. Your finger was splinted in the Emergency Department_. Keep the splint clean and dry.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience any new or worsening finger pain, [[Numbness]], weakness, [[Discoloration]], fevers, or any other concerning symptoms.	
DCFootPain	
You have been evaluated in the Olive View-UCLA Emergency Department today for foot pain. The x-ray of your foot shows _.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your foot to control your pain.	
Please follow up with your primary care physician within two days as needed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with a podiatrist in about 1 week. You can find an podiatrist by calling (818) 364-3676.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.	
DCFracture	
You have been evaluated in the Olive View-UCLA Emergency Department today for your injury while _. Your evaluation, including an x-ray of your _, have revealed a fracture of your _. Your __has been splinted in the ER.	
Please rest, ice, and elevate your __to control pain and inflammation. Please take Tylenol of Motrin as needed for pain. Take vicodin for as needed for severe pain. Do not drive or operate heavy machinery while taking vicodin.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with an orthopedic surgeon in about 1 week. You can go to your primary care doctor or follow up with the referral we have given you. Please call (818) 364-3676 if you do not receive a call for your appointment time.	
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.	
DC[[Gallstone (Cholelithiasis)]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Abdominal Pain]]. Your evaluation suggests that your pain is due to [[Gallstone (Cholelithiasis)]]. It is not emergent at this time but it is recommended that you make an appointment at a surgery clinic to be evaluated to have your [[Gallbladder]] removed.	
We will give you a referral to general surgery at olive view. They will call you with an appointment time in the future to discuss elective surgery. P lease call (818) 364-3129 if you do not receive an appointment date.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, fever, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], [[SOB (Shortness of Breath)]], or any other concerning symptoms.	
DC[[Gastroenteritis]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to a viral gastroenterological infection which will improve on its own.	
Remember to drink plenty of clear fluids at home and eat a bland diet.	
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, recurrent vomiting, blood in your vomit, difficulty breathing, fevers 100.4°F or greater, or any other concerning symptoms.	
You were evaluated in the Olive View-UCLA Emergency Department today for neck pain. Your _ suggests no acute abnormalities which require further intervention at this time.	
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain.	
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening neck pain, incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.	
DC[[Gastroenteritis]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to a viral gastroenterological infection which will improve on its own.	
Remember to drink plenty of clear fluids at home and eat a bland diet.	
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, recurrent vomiting, blood in your vomit, difficulty breathing, fevers 100.4°F or greater, or any other concerning symptoms.	
DC[[Gastroenteritis]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to a viral gastroenterological infection which will improve on its own.	
Remember to drink plenty of clear fluids at home and eat a bland diet.	
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, recurrent vomiting, blood in your vomit, difficulty breathing, fevers 100.4°F or greater, or any other concerning symptoms.	
DC[[Head Injury]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your evaluation suggests _.	
You will likely feel a little worse tomorrow due to the trauma please rest and control your pain by alternating Tylenol and Motrin every 4-6 hours as directed on the package. You should avoid contact sports, running, playing video games and studying for long periods of time.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience [[Severe Headache]], vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.	
DCHeadache	
You have been evaluated in the Olive View-UCLA Emergency Department today for headache. Your evaluation suggests _. Your pain improved with medication.	
Please control your pain by alternating Tylenol and Motrin every 4-6 hours as directed on the package.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]]/tingling, weakness, or any other concerning symptoms.	
DC[[Hemorrhoid (Pile)]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Hemorrhoid (Pile)]]. You were given a prescription for topical cream_ and stool softeners to help with your symptoms. Use a [[Sitz Bath]] and rest to help control your pain (instructions can be found at http://www.webmd.com/digestive-disorders/sitz-bath). Drink plenty of fluids.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, worsening bleeding in your stool, recurrent vomiting, blood in vomit, [[SOB (Shortness of Breath)]], fevers or any other concerning symptoms.	
DCHernia	
You have been evaluated in the Olive View-UCLA Emergency Department today for pain secondary to your hernia. Your evaluation suggests that you do not need any emergent surgery to repair your hernia today.	
Please follow up with your primary care physician within the next week. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please arrange to see a general surgeon for elective surgery through your primary care doctor. If you do not have a primary care doctor, we will refer to surgery here, you will receive a phone call for an appointment time. If you do not get an appointment, you can call Outpatient Surgery Clinic, (818) 364-3129.	
Return to the Emergency Department if you experience worsening pain, fever, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], [[SOB (Shortness of Breath)]], or any other concerning symptoms.	
DCIngrownToenail	
You have been evaluated in the Olive View-UCLA Emergency Department today for toe pain from an ingrown toe nail.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your foot to control your pain, as well as soak your foot in water 1-2 times daily and place an antibiotic ointment in the corner of your toenail and cover with a bandage.	
Please follow up with a podiatrist to treat your ingrown toenail. You can call 818- 364- 3676 to find a podiatry appointment at Olive View-UCLA.	
Return to the Emergency Department if you experience worsening pain, worsening swelling, fevers 100.4°F or greater, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.	
DCKidneyStone	
You have been evaluated in the Olive View-UCLA Emergency Department today for a [[Nephrolithiasis ((Kidney; Renal) Stone(s))]]. The stone will pass on its own and will be expelled in the urine. Please use the strainer as directed to strain your urine until your stone passes. Please read the information provided to you on discharge.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, fever, painful urination, [[Blood In Urine]], weakness, chest pain, difficulty breathing or any other concerning symptoms.	
DCKneePain	
You have been evaluated in the Olive View-UCLA Emergency Department today for knee pain. The x-ray of your knee shows_.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your leg to control your pain.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, or any other concerning symptoms.	
DCLaceration	
You were evaluated in the Olive View-UCLA Emergency Department today for a laceration of your _. Your laceration was closed with sutures_ in the Emergency Department. Please keep the area surrounding the laceration clean and dry.	
Please follow up with your primary care physician in 7-10 days to get your sutures removed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, [[Numbness]], tingling, or any other concerning symptoms.	
DCLegSwelling	
You were evaluated in the UCLA Emergency Department today for leg swelling. Your [[PE (Physical Exam(ination))]] and _ reveal _.	
Please rest and keep your leg elevated. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience [[SOB (Shortness of Breath)]], chest pain, palpitations, nausea/vomiting or any other concerning symptoms.	
DCMVC	
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation has revealed __. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.	
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco as needed for severe pain. Do not drive or operate heavy machinery while taking norco.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.	
DCMVC	
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation has revealed __. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.	
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco as needed for severe pain. Do not drive or operate heavy machinery while taking norco.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.	
DCMVC	
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation has revealed __. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.	
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco as needed for severe pain. Do not drive or operate heavy machinery while taking norco.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.	
DCMedRefill	
You were evaluated in the Olive View-UCLA Emergency Department today for a medication refill.	
It is very important that you establish primary care with a physician if you have not already done so to gain an optimal regimen for your medical conditions. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience chest pain, [[SOB (Shortness of Breath)]], [[Numbness]]/tingling, or any other concerning symptoms.	
DCMedRefill	
You were evaluated in the Olive View-UCLA Emergency Department today for a medication refill.	
It is very important that you establish primary care with a physician if you have not already done so to gain an optimal regimen for your medical conditions. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience chest pain, [[SOB (Shortness of Breath)]], [[Numbness]]/tingling, or any other concerning symptoms.	
DCMedRefill	
You were evaluated in the Olive View-UCLA Emergency Department today for a medication refill.	
It is very important that you establish primary care with a physician if you have not already done so to gain an optimal regimen for your medical conditions. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience chest pain, [[SOB (Shortness of Breath)]], [[Numbness]]/tingling, or any other concerning symptoms.	
DCMuscleStrain	
You have been evaluated in the Olive View-UCLA Emergency Department today for your __ pain after _. Your pain is most likely muscle strain which will improve on its own.	
Please rest, ice, and elevate your _to control pain and inflammation.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.	
DCMuscleStrain	
You have been evaluated in the Olive View-UCLA Emergency Department today for your __ pain after _. Your pain is most likely muscle strain which will improve on its own.	
Please rest, ice, and elevate your _to control pain and inflammation.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.	
DCMuscleStrain	
You have been evaluated in the Olive View-UCLA Emergency Department today for your __ pain after _. Your pain is most likely muscle strain which will improve on its own.	
Please rest, ice, and elevate your _to control pain and inflammation.	
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.	
DCNeck Pain	
You were evaluated in the Olive View-UCLA Emergency Department today for neck pain. Your _ suggests no acute abnormalities which require further intervention at this time.	
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain.	
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening neck pain, incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.	
DCNeck Pain	
You were evaluated in the Olive View-UCLA Emergency Department today for neck pain. Your _ suggests no acute abnormalities which require further intervention at this time.	
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain.	
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening neck pain, incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.	
DC[[Numbness]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Numbness]] in your _. Your evaluation, including labs and imaging_, suggests that your symptoms are due to __.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
DC[[Numbness]]	
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Numbness]] in your _. Your evaluation, including labs and imaging_, suggests that your symptoms are due to __.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
DCPEDSAbdominalPain	
Your child has been evaluated in the Olive View-UCLA Emergency Department today. Their evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of the current condition.	
Please follow up with your pediatrician within one to two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department immediately if your child has worsening [[Abdominal Pain]], persistent fevers of 100.4°F or greater, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], or any other concerning symptoms.	
DCPEDSAbdominalPain	
Your child has been evaluated in the Olive View-UCLA Emergency Department today. Their evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of the current condition.	
Please follow up with your pediatrician within one to two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department immediately if your child has worsening [[Abdominal Pain]], persistent fevers of 100.4°F or greater, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], or any other concerning symptoms.	
DCPEDSFever	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a fever. Their evaluation suggests that the symptoms are likely due to a viral illness_. Viral illnesses should resolve on their own_.	
Please alternate Tylenol and Motrin every 4-6 hours to help control fever and give plenty of fluids.	
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department immediately if your child experiences persistent fevers greater than 100.4°F that cannot be controlled with Tylenol/Motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], difficulty breathing, or any other concerning symptoms.	
DCPEDSFever	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a fever. Their evaluation suggests that the symptoms are likely due to a viral illness_. Viral illnesses should resolve on their own_.	
Please alternate Tylenol and Motrin every 4-6 hours to help control fever and give plenty of fluids.	
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department immediately if your child experiences persistent fevers greater than 100.4°F that cannot be controlled with Tylenol/Motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], difficulty breathing, or any other concerning symptoms.	
DCPEDSHeadTrauma	
Your child has been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your child’s evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your child was observed in the ED without any evidence of neurological instability.	
Please follow up with your child’s pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences worsening headaches, vision changes, recurrent vomiting, difficulty with normal activities, [[Lethargy]], abnormal behavior, difficulty walking, weakness, persistent fevers, or any other concerning symptoms.	
DCPEDSHeadTrauma	
Your child has been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your child’s evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your child was observed in the ED without any evidence of neurological instability.	
Please follow up with your child’s pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences worsening headaches, vision changes, recurrent vomiting, difficulty with normal activities, [[Lethargy]], abnormal behavior, difficulty walking, weakness, persistent fevers, or any other concerning symptoms.	
DCPEDSLaceration	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a laceration. Their laceration was closed with sutures in the Emergency Department. Please keep the area surrounding the laceration clean and dry. To minimize scarring reduce sun exposure for the next year by wearing sunscreen, hats and long clothing.	
Please follow up with your pediatrician within two days for a wound check. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences discharge from the laceration, redness around the laceration, warmth around the laceration, persistent fevers, recurrent vomiting, or any other concerning symptoms.	
DCPEDSLaceration	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a laceration. Their laceration was closed with sutures in the Emergency Department. Please keep the area surrounding the laceration clean and dry. To minimize scarring reduce sun exposure for the next year by wearing sunscreen, hats and long clothing.	
Please follow up with your pediatrician within two days for a wound check. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences discharge from the laceration, redness around the laceration, warmth around the laceration, persistent fevers, recurrent vomiting, or any other concerning symptoms.	
DCPEDSOrtho	
Your child has been evaluated in the Olive View-UCLA Emergency Department today for _ pain. Their evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable_.	
Please rest, ice, and elevate to control pain and inflammation. Please give your child tylenol/motrin as directed in the attached dosing instructions for discomfort.	
Please follow up with your Pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Please follow up with a pediatric orthopedic surgeon in about 1 week. You can find a pediatric by follow up with a pediatrician.	
Return to the Emergency Department if your child experiences worsening pain, change of color in their _, persistent fevers, recurrent vomiting, or any other concerning symptoms.	
DCPEDSOrtho	
Your child has been evaluated in the Olive View-UCLA Emergency Department today for _ pain. Their evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable_.	
Please rest, ice, and elevate to control pain and inflammation. Please give your child tylenol/motrin as directed in the attached dosing instructions for discomfort.	
Please follow up with your Pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Please follow up with a pediatric orthopedic surgeon in about 1 week. You can find a pediatric by follow up with a pediatrician.	
Return to the Emergency Department if your child experiences worsening pain, change of color in their _, persistent fevers, recurrent vomiting, or any other concerning symptoms.	
DCPEDSRash	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a rash. Their evaluation suggests _.	
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences difficulty breathing or swallowing, lip/mouth/[[Tongue]] swelling, persistent fevers >100.4 that cannot be controlled with tylenol/motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], discharge from his rash, or any other concerning symptoms.	
DCPEDSRash	
Your child was evaluated in the Olive View-UCLA Emergency Department today for a rash. Their evaluation suggests _.	
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if your child experiences difficulty breathing or swallowing, lip/mouth/[[Tongue]] swelling, persistent fevers >100.4 that cannot be controlled with tylenol/motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], discharge from his rash, or any other concerning symptoms.	
DCPEDSURI	
Your child was evaluated in the Olive View-UCLA Emergency Department today for cough. Their [[PE (Physical Exam(ination))]] suggests that their symptoms are likely due to a viral illness. Viral illnesses should resolve on their own over time. You should give tylenol or motrin as needed using the directions provided to you and give plenty of fluids.	
Please follow up with their pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if XXXX experiences worsening cough, trouble breathing, fever, recurrent vomiting, [[Lethargy]], or any other concerning symptoms.	
DCPEDSURI	
Your child was evaluated in the Olive View-UCLA Emergency Department today for cough. Their [[PE (Physical Exam(ination))]] suggests that their symptoms are likely due to a viral illness. Viral illnesses should resolve on their own over time. You should give tylenol or motrin as needed using the directions provided to you and give plenty of fluids.	
Please follow up with their pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.	
Return to the Emergency Department if XXXX experiences worsening cough, trouble breathing, fever, recurrent vomiting, [[Lethargy]], or any other concerning symptoms.	
DCPalpitations	
You have been evaluated in the Olive View-UCLA Emergency Department today for palpitations. Your evaluation suggests _.	
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for persistent periods of very rapid heart rate that is associated with [[SOB (Shortness of Breath)]], worsening fatigue with trouble exercising, chest pain, [[Dizziness]], [[Fainting]], or for any other concerning symptoms.	
DCPalpitations	
You have been evaluated in the Olive View-UCLA Emergency Department today for palpitations. Your evaluation suggests _.	
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for persistent periods of very rapid heart rate that is associated with [[SOB (Shortness of Breath)]], worsening fatigue with trouble exercising, chest pain, [[Dizziness]], [[Fainting]], or for any other concerning symptoms.	
DCPenile	
You were examined in the Olive View-UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that _.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with your primary care doctor for an appointment with a urologist. Call (818) 364-3129 if you were not given an appointment time over the phone with an Olive View-UCLA urologist.	
Return to the Emergency Department immediately if you experience worsening penile pain, increasing redness or discharge from the penis, fevers or any other concerning symptoms.	
DCPenile	
You were examined in the Olive View-UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that _.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with your primary care doctor for an appointment with a urologist. Call (818) 364-3129 if you were not given an appointment time over the phone with an Olive View-UCLA urologist.	
Return to the Emergency Department immediately if you experience worsening penile pain, increasing redness or discharge from the penis, fevers or any other concerning symptoms.	
DCPsych	
You have been evaluated in the Olive View-UCLA Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff_ and have been cleared to go home.	
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.	
Psychiatric Urgent Care	
14659 Olive View Dr.	
Sylmar, CA 91342	
(818) 485-0888	
HRS M-F 8am-10pm Sat-Sun 9am-5:30pm	
Return to the Emergency Department immediately if you experience thoughts of hurting yourself or others, audio or visual [[Hallucinations]], or for any other concerning symptoms.	
DCPsych	
You have been evaluated in the Olive View-UCLA Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff_ and have been cleared to go home.	
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.	
Psychiatric Urgent Care	
14659 Olive View Dr.	
Sylmar, CA 91342	
(818) 485-0888	
HRS M-F 8am-10pm Sat-Sun 9am-5:30pm	
Return to the Emergency Department immediately if you experience thoughts of hurting yourself or others, audio or visual [[Hallucinations]], or for any other concerning symptoms.	
DC[[Pyelonephritis]]	
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a kidney infection ([[Pyelonephritis]]). Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
DC[[Pyelonephritis]]	
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a kidney infection ([[Pyelonephritis]]). Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
DCSOB	
You were evaluated in the Olive View-UCLA Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Prednisone]]_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms	
You have been evaluated in the Olive View UCLA Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable// reveal a shoulder dislocation_. We have reduced your shoulder, please use the sling for comfort_.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with an orthopedic surgeon in about 1 week with your primary care doctor. If you were referred to one from Olive View, please follow up with your scheduled appointment that you should receive a phone call for.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests__.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Genital Lesions]]_. Your [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] tests are still pending_; you have been given treatment for these infections presumptively _.	
Please take your prescribed antibiotics for the full course of the medication as directed.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today after a syncopal episode. Your evaluation suggests that your symptoms are due to [[Vasovagal Syncope]]_. Your [[PE (Physical Exam(ination))]] was not suggestive of any emergent condition requiring medical intervention. Your EKG was normal_.	
Please take tylenol or motrin as needed for pain using the directions on the box.	
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.	
You were examined in the Olive View-UCLA Emergency Department today for [[Testicular Pain]]. The [[US(G) (Ultra(sound; -sonogram; sonography))]] of your testicles did not show torsion_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Follow up with your primary doctor to make an appointment with a urologist or follow up with the referral given to you. You should receive a telephone call with an appointment time if you were referred to UCLA-Olive View	
Return to the Emergency Department immediately if you experience worsening [[Testicular Pain]], penile pain, redness or discharge from your penis, fevers or any other concerning symptoms.	
You have been evaluated in the Olive View UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]], cough, runny nose, fevers, and body aches. Your evaluation suggests that your symptoms are most likely to due a viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]] which will improve on its own.	
Drink plenty of fluids at home. Take Tylenol/Motrin as needed using the directions on the box.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
You were evaluated in the Olive View-UCLA Emergency Department today for [[Urinary Retention]]. We have placed a [[Foley Catheter]]_. Keep the bag attached to your leg and empty when full. If you do not have any [[Urine Output]], or if the urine is cloudy or bloody, call your primary doctor or return to the ER.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed_.	
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
You were evaluated in the Olive View-UCLA Emergency Department today for [[Vaginal Bleeding]]. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] and labs show _.	
Please follow up with your OB/GYN within two days. If you do not have an OB/GYN doctor, please arrange to see a specialist with your primary doctor or follow up with the referral with a Olive View-UCLA OB/GYN.	
Return to the Emergency Department if you experience severe [[Abdominal Pain]], worsening [[Vaginal Bleeding]], [[Dizziness]], fevers, recurrent vomiting, or any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for a wound check. Your wound appears to be healing well; there is no evidence of infection_.	
Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, spreading redness from your wound, pus from your wound, fevers 100.4° of greater, [[Numbness]]/tingling or weakness, or for any other concerning symptoms.	
You have been evaluated in the Olive View-UCLA Emergency Department today for wrist pain. Your evaluation, including [[PE (Physical Exam(ination))]] and x-ray, has revealed that you have a fracture of your _ OR _ no evidence of any acute fractures or dislocations_.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.	
Please also rest, ice, and elevate your arm to control pain and inflammation.	
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with a hand surgeon within 1 week by calling (818) 364-3132.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms	
DCSOB	
You were evaluated in the Olive View-UCLA Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Prednisone]]_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms	
DCSOB	
You were evaluated in the Olive View-UCLA Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Prednisone]]_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms	
DCSTI	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Genital Lesions]]_. Your [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] tests are still pending_; you have been given treatment for these infections presumptively _.	
Please take your prescribed antibiotics for the full course of the medication as directed.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.	
DCSTI	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Genital Lesions]]_. Your [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] tests are still pending_; you have been given treatment for these infections presumptively _.	
Please take your prescribed antibiotics for the full course of the medication as directed.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.	
DCSeizure	
You have been evaluated in the Olive View-UCLA Emergency Department today for a seizure. Your evaluation, including labs and CT of your brain, were unremarkable_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Follow up with your primary care doctor to make an appointment with a neurologist. If you were referred to a neurologic here at Olive View-UCLA, please follow up with that appointment which you will be called for.	
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
DCSeizure	
You have been evaluated in the Olive View-UCLA Emergency Department today for a seizure. Your evaluation, including labs and CT of your brain, were unremarkable_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Follow up with your primary care doctor to make an appointment with a neurologist. If you were referred to a neurologic here at Olive View-UCLA, please follow up with that appointment which you will be called for.	
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
DCShoulderPain	
You have been evaluated in the Olive View UCLA Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable// reveal a shoulder dislocation_. We have reduced your shoulder, please use the sling for comfort_.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with an orthopedic surgeon in about 1 week with your primary care doctor. If you were referred to one from Olive View, please follow up with your scheduled appointment that you should receive a phone call for.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.	
DCShoulderPain	
You have been evaluated in the Olive View UCLA Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable// reveal a shoulder dislocation_. We have reduced your shoulder, please use the sling for comfort_.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with an orthopedic surgeon in about 1 week with your primary care doctor. If you were referred to one from Olive View, please follow up with your scheduled appointment that you should receive a phone call for.	
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.	
DCSoreThroat	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests__.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
DCSoreThroat	
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests__.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
DCSyncope	
You have been evaluated in the Olive View-UCLA Emergency Department today after a syncopal episode. Your evaluation suggests that your symptoms are due to [[Vasovagal Syncope]]_. Your [[PE (Physical Exam(ination))]] was not suggestive of any emergent condition requiring medical intervention. Your EKG was normal_.	
Please take tylenol or motrin as needed for pain using the directions on the box.	
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.	
DCSyncope	
You have been evaluated in the Olive View-UCLA Emergency Department today after a syncopal episode. Your evaluation suggests that your symptoms are due to [[Vasovagal Syncope]]_. Your [[PE (Physical Exam(ination))]] was not suggestive of any emergent condition requiring medical intervention. Your EKG was normal_.	
Please take tylenol or motrin as needed for pain using the directions on the box.	
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.	
DCTesticularpain	
You were examined in the Olive View-UCLA Emergency Department today for [[Testicular Pain]]. The [[US(G) (Ultra(sound; -sonogram; sonography))]] of your testicles did not show torsion_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Follow up with your primary doctor to make an appointment with a urologist or follow up with the referral given to you. You should receive a telephone call with an appointment time if you were referred to UCLA-Olive View	
Return to the Emergency Department immediately if you experience worsening [[Testicular Pain]], penile pain, redness or discharge from your penis, fevers or any other concerning symptoms.	
DCTesticularpain	
You were examined in the Olive View-UCLA Emergency Department today for [[Testicular Pain]]. The [[US(G) (Ultra(sound; -sonogram; sonography))]] of your testicles did not show torsion_.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Follow up with your primary doctor to make an appointment with a urologist or follow up with the referral given to you. You should receive a telephone call with an appointment time if you were referred to UCLA-Olive View	
Return to the Emergency Department immediately if you experience worsening [[Testicular Pain]], penile pain, redness or discharge from your penis, fevers or any other concerning symptoms.	
DCURI	
You have been evaluated in the Olive View UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]], cough, runny nose, fevers, and body aches. Your evaluation suggests that your symptoms are most likely to due a viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]] which will improve on its own.	
Drink plenty of fluids at home. Take Tylenol/Motrin as needed using the directions on the box.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
DCURI	
You have been evaluated in the Olive View UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]], cough, runny nose, fevers, and body aches. Your evaluation suggests that your symptoms are most likely to due a viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]] which will improve on its own.	
Drink plenty of fluids at home. Take Tylenol/Motrin as needed using the directions on the box.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.	
DCUrinaryRetention	
You were evaluated in the Olive View-UCLA Emergency Department today for [[Urinary Retention]]. We have placed a foley catheter_. Keep the bag attached to your leg and empty when full. If you do not have any [[Urine Output]], or if the urine is cloudy or bloody, call your primary doctor or return to the ER.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
DCUrinaryRetention	
You were evaluated in the Olive View-UCLA Emergency Department today for [[Urinary Retention]]. We have placed a foley catheter_. Keep the bag attached to your leg and empty when full. If you do not have any [[Urine Output]], or if the urine is cloudy or bloody, call your primary doctor or return to the ER.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.	
DCVaginalBleed	
You were evaluated in the Olive View-UCLA Emergency Department today for [[Vaginal Bleeding]]. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] and labs show _.	
Please follow up with your OB/GYN within two days. If you do not have an OB/GYN doctor, please arrange to see a specialist with your primary doctor or follow up with the referral with a Olive View-UCLA OB/GYN.	
Return to the Emergency Department if you experience severe [[Abdominal Pain]], worsening [[Vaginal Bleeding]], [[Dizziness]], fevers, recurrent vomiting, or any other concerning symptoms.	
DCVaginalBleed	
You were evaluated in the Olive View-UCLA Emergency Department today for [[Vaginal Bleeding]]. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] and labs show _.	
Please follow up with your OB/GYN within two days. If you do not have an OB/GYN doctor, please arrange to see a specialist with your primary doctor or follow up with the referral with a Olive View-UCLA OB/GYN.	
Return to the Emergency Department if you experience severe [[Abdominal Pain]], worsening [[Vaginal Bleeding]], [[Dizziness]], fevers, recurrent vomiting, or any other concerning symptoms.	
DCWeakness	
You have been evaluated in the Olive View-UCLA Emergency Department today for general weakness. Your evaluation, including _, were within normal limits and not suggestive of any emergent condition requiring medical intervention at this time.	
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.	
DCWoundcheck	
You have been evaluated in the Olive View-UCLA Emergency Department today for a wound check. Your wound appears to be healing well; there is no evidence of infection_.	
Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, spreading redness from your wound, pus from your wound, fevers 100.4° of greater, [[Numbness]]/tingling or weakness, or for any other concerning symptoms.	
DCWoundcheck	
You have been evaluated in the Olive View-UCLA Emergency Department today for a wound check. Your wound appears to be healing well; there is no evidence of infection_.	
Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, spreading redness from your wound, pus from your wound, fevers 100.4° of greater, [[Numbness]]/tingling or weakness, or for any other concerning symptoms.	
DCWrist Pain	
You have been evaluated in the Olive View-UCLA Emergency Department today for wrist pain. Your evaluation, including physical exam and x-ray, has revealed that you have a fracture of your _ OR _ no evidence of any acute fractures or dislocations_.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.	
Please also rest, ice, and elevate your arm to control pain and inflammation.	
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with a hand surgeon within 1 week by calling (818) 364-3132.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms	
Memory Tools	
DCWrist Pain	
You have been evaluated in the Olive View-UCLA Emergency Department today for wrist pain. Your evaluation, including physical exam and x-ray, has revealed that you have a fracture of your _ OR _ no evidence of any acute fractures or dislocations_.	
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.	
Please also rest, ice, and elevate your arm to control pain and inflammation.	
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.	
Please follow up with a hand surgeon within 1 week by calling (818) 364-3132.	
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms	
Memory Tools	
Memory Tools	
[[Exclusion Criteria]]	
 Significant head trauma or prior stroke in previous 3 months	
 Symptoms suggest [[SAH (Subarachnoid Hemorrhage)]]	
 History of previous [[ICH (Intracranial Hemorrhage)]]	
 Intracranial neoplasm, [[AVM (Arteriovenous Malformation)]], or [[Aneurysm]]	
 Recent intracranial or intraspinal surgery	
 [[Arterial Puncture]] at noncompressible site in previous 7 days	
[[↑↑↑ [[BP (Blood P (Pressure))]] ↑↑↑]]	
(systolic >185 mm Hg or diastolic >110 mm Hg)	
 Active internal bleeding	
 Blood glucose concentration <50mg/dl (2.7mmol/L)	
 Acute bleeding diathesis, including but not limited to: Platelet count <100 000/mm³ (In patients without history of [[Thrombocytopenia]],	
treatment with IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm³.)	
 [[Heparin]] received within 48 hours, resulting in abnormally elevated [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]] greater than the upper limit of normal	
 Current use of anticoagulant with INR >1.7 or PT >15 seconds (In patients without recent use of oral [[Anti(-)Coagulant(s)]] or [[Heparin]], treatment with	
IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT	
is abnormally elevated by local laboratory standards.)	
 Current use of [[DTI (Direct Thrombin Inhibitor)]]s or direct [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] inhibitors with elevated sensitive laboratory tests (such as [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]], INR, platelet	
count, and ECT; TT; or appropriate [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] activity assays)	
 CT demonstrates multilobar [[Infarction]] (hypodensity >1/3 cerebral hemisphere)	
MDMPEPOccHealth	
with occupational work exposure with relatively low risk of transmission. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]], C and HIV and relative rates given source patient and mechanism. [[Immunization]]s UTD as above, specifically [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] and [[Hepatitis B Vaccination]]s. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given relatively low risk of transmission, mutual [[Decision Making]] to defer PEP at this time. Discussed prompt follow up with occupational health for bloodwork and serial serologies as needed.	
NIH Stroke Scale	
Interval: {NIHSS interval:17994}	
Time: {Time; 0100-2400:14903} ***	
Person Administering Scale: ***	
1a. Level of consciousness:{exam; consciousness neuro:31423}	
1b. LOC questions: (month; age) * 0 – answers both questions correctly * 1 – one question correctly *** 2 – neither question correctly	
1c. LOC commands: [open/close eyes; grip/ release hand or other 1-step command]{Loc commands neuro:31401}	
2. Best Gaze: [test horizontal only. Isolated peripheral [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]],4,6 palsy =1]{exam; best gaze neuro:31402}	
3. Visual: [upper & lower VF quadrants]{Visual neuro:31403}	
4. [[Facial Palsy]]: [show teeth, raise eyebrows, close eyes]{Exam; neuro [[Facial Palsy]]:31404}	
5a. Motor left arm: [extend arms]{Motor arm:27865}	
5b. Motor right arm:{Motor arm:27865}	
6a. Motor left leg: [hold 30 degrees supine]{Motor leg:27866}	
6b. Motor right leg: [hold 30 degrees supine]{Motor leg:27866}	
7. Limb Ataxia: [w/ eyes open. (B) Finger to nose; (B) heel to shin. ‘0’ if paralyzed or does not understand]{Limb ataxia neuro:31406}	
8. Sensory: [to pinprick. If coma-> 2] {SENSORY:18028}	
9. Best Language: [describe picture; name items in picture; read sentences]{exam; best language neuro:31408}	
10. [[Dysarthria]]:[read or repeat words]{[[Dysarthria]] neuro:31409}	
11. Extinction and Inattention: {findings; extinction neuro:31410}	
Total: {0-42:17997}	
Note:	
A patient with a completely normal neurological exam and normal mental status	
will have an NIHSS of 0. The maximum recordable [[NIHSS Score]] is 42. However,	
since acute [[Ischemic Stroke]] causes unilateral paralysis and [[Blindness]], the maximum	
score actually is 31 for a stroke patient with complete hemiparesis, [[Hemianopia]],	
hemineglect, and aphasia.	
Patients with an [[NIHSS Score]] greater than 15-20 are considered to have a severe	
stroke clinically.	
NYSDOH AI Recommendations (2014)	
Indication: Percutaneous or [[Mucocutaneous]] exposure with blood or visibly [[Bloody Fluid]] or other potentially infectious material.	
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily or [[Lamivudine (EPIVIR)]] 300 mg PO daily plus Either Raltegravir 400 mg PO twice daily or [[Dolutegravir (DOVATO)]] 50 mg PO daily	
HIV Antibody Testing of Healthcare Worker	
Baseline	
4 weeks post-exposure	
12 weeks post-exposure	
When a potential [[Occupational Exposure]] to HIV occurs, every effort should be made to initiate PEP, as soon as possible, ideally within 2 hours. A first dose of PEP should be offered to the exposed worker while the evaluation is underway. In addition, PEP should not be delayed while awaiting information about the source or results of the exposed individual’s baseline HIV test.	
Decisions regarding initiation of PEP beyond 36 hours post exposure should be made on a case-by-case basis with the understanding of diminished efficacy when timing of initiation is prolonged.	
Relative [[Exclusion Criteria]]	
Recent experience suggests that under some circumstances—with careful consideration and weighting of risk to benefit—patients may receive	
fibrinolytic therapy despite 1 or more relative contraindications. Consider risk to benefit of IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] administration carefully if any of these relative	
contraindications are present:	
 Only minor or rapidly improving stroke symptoms (clearing spontaneously)	
 Seizure at onset with postictal residual neurological impairments	
 Major surgery or serious trauma within previous 14 days	
 Recent gastrointestinal or urinary tract [[Hemorrhage]] (within previous 21 days)	
 Pregnancy	
http://www.mdcalc.com/heart-score-for-major-cardiac-events/	
Upon calculating the patient’s HEART score, they were found to have a score of 0-3, which indicates low risk, so the patient can be safely discharged with the understanding that they need to make an appointment with a primary care doctor to be referred for a stress test within the next 48-72 hours, or if they cannot arrange that they are to return to the ED, or sooner than that if they have any changing, persistent, or worsening symptoms.	
In the studies referenced below, the patients in the low risk group were discharged and found to have a 0.9-1.7% change of having a major adverse cardiac event (defined as revascularization, [[MI (Myocardial Infarction)]], or all-cause mortality) within 6 weeks when studied both retrospectively and prospectively.	
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008 Jun;16(6):191-6. PMID: 18665203	
Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. PMID: 23465250.	
Resources	
RESPsych	
COMMUNITY PSYCHIATRY REFERRALS	
Suicide Hotline: 877-727-4747 or 800-273-TALK (273-8255) or 888-628-9454 (Spanish)	
Los Angeles County Psychiatric Emergency Team/PMRT:	
310-618-9687 or 800-854-7771	
LAPD SMART Team:	
(213) 485-3300	
Call your insurance for a list of psychiatrists and psychotherapists and outpatient programs.	
Exodus Urgent Care Center:	
Culver City: (310) 253-9494, 3828 Delmas Terrace, Culver City	
Downtown Los Angeles: 323-276-6400, 1920 Marengo Street, Los Angeles	
Fresno: 559-512-8335, 4411 East Kings Canyon Road	
Open 24 hours per day, 365 days per year, on a walk-in basis	
individuals in crisis can be assessed for stabilization services, medication refills/ evaluation and management, or hospitalization if necessary.	
Los Angeles County Mental Health Clinics: must present to the clinic designated for service area. Call 24/7 Access Line: 1-800-854-7771 for clinic locations, hours, etc.	
Antelope Valley: 661-723-4260, 349 East Avenue K-6, Lancaster 93535	
Arcadia: 626-821-5858, 330 E. Live Oak Avenue, Arcadia 91006	
Augustus Hawkins: 310-668-4271, 1720 E. 120th Street, Los Angeles, 90059	
Compton: (310) 668-6800, 1600 E. Compton Blvd, Compton, CA 90220	
Culver City: Didi Hirsch (310) 390-6612, 4760 Sepulveda Blvd.	
Downtown: 213-430-6700, 529 Maple Avenue, Los Angeles 90013	
Glendale: 818-244-7257, 1538 Colorado Blvd	
Hollywood: (323) 769-6100, 1224 Vine Street, Los Angeles 90038	
La Puente: 818-961-8971, 160 S. 7th St	
Long Beach: (562) 599-9280, 1975 Long Beach Blvd., Long Beach 90806	
North East: 323-478-8200, 5321 Via Marisol, Los Angeles, CA, 90042	
Palmdale: 661-575-1800, 1529 E. Palmdale Blvd, Suite 150, Palmdale 93550	
Rio Hondo: 562-402-0688, 17707 Studebaker Road, Cerritos 90703	
San Fernando: 818-832-2400, 10605 Balboa Blvd, Suite 100, Granada Hills 91344	
San Pedro: 310-519-6100, 150 West 7th Street, San Pedro, 90731	
Santa Clarita: 661-288-4800, 23501 Cinema Drive, Valencia 91355	
South Bay: 323-241-6730, 2311 W. El Segundo Boulevard, Hawthorne 90250	
Sylmar: Hillview Mental Health Center (818) 896-1161 X211, 11500 Eldridge Ave.	
West Central: 323-298-3680, 3751 Stocker Street, Los Angeles 90008	
West LA: Edelman (310) 966-6500, 11080 West Olympic Boulevard, Los Angeles, CA 90064	
West Valley: 818-598-6967, 7621 Canoga Avenue, Canoga Park 91304	
Venice Family Clinic: (310) 392-8636	
Walk-in appointments:	
604 Rose Ave. 10-11:30 M, W-F or 2-3:30 M, T, F	
2509 Pico Blvd. 10-11:30 M/F or 2-3:30 T, W, F	
905 Venice Blvd. (teens only) 2-5 M-W	
4700 Inglewood Blvd. Th 3:30-4:30	
Other County Mental Health Clinics:	
Orange County Mental Health: (714) 568-4463	
Riverside County Mental Health: (909) 358-4705	
San Bernadino County Mental Health (909) 387-7171	
Santa Barbara County Mental Health (805) 681-5220	
Tri-City Mental Health (909) 623-6131	
Ventura County Mental Health (805) 652-6737	
Los Angeles Gay & Lesbian Center	
(323) 993-7500 1625 North Schrader Boulevard, Los Angeles	
Counseling offered on a sliding fee scale basis. Support groups, HIV care, anger management, case management and other services also available.	
HIV/AIDS Resources	
APLA-AIDS Project Los Angeles- (213) 201-1388	
AHF-AIDS Healthcare Foundation- (323) 860-5200	
CHIRPLA-Housing- (213) 741-1951	
Oasis Clinic-Medical Issues- (310) 668-5033	
UCLA CARE Clinic-(310) 557-2273	
Homeless Shelters (below are contact numbers to inform you of available local shelters)	
Access Center 800-854-7771-will inform of available shelters in local areas	
Cold Weather Shelters 800-548-6047	
United Way 310-603-8962	
Homeless Drop-In Centers:	
OPCC Access Center: 1616 7th Street, Santa Monica (310) 450-4050	
Drop-in center for clothing, showers, sack lunches, and referrals to shelters	
St. Joseph’s Homeless Service Center 404 Lincoln Boulevard, Venice (310) 399-6878 x407	
Emergency services, including shower, laundry, mail, clothing, counseling, and case management. All services provided free of charge. Orientation 8am M-F.	
Step-Up on Second 2701 Ocean Park Boulevard, #150B Santa Monica (310) 392-9474	
Psychotherapy, groups, case management, meals, drop-in center, and other services.	
Homeless Health Care (HHCLA) 2330 Beverly Boulevard, Los Angeles, CA (213) 744-0724	
Wide ranging outpatient services—therapy, psychiatry, groups, case management, referrals. All qualify for services.	
Beyond Shelter 1200 Wilshire Boulevard, Los Angeles (213) 252-0772	
Cornerstone 14000 Oxnard Street, Van Nuys (818) 901-4836	
Walk-in drop-in center. Assistance with housing, groups, therapy, psychiatry. Meals	
Long Beach Multi-Service Center	
1301 W. 12th Street, Long Beach, (562) 733-1147	
Outreach, case management and housing placement services. laundry, showers.	
Domestic Violence Shelters	
Domestic Violence Drop-In and Resource Center (310) 464-6281	
Jewish Family Service DV Program (818) 505-0900, Los Angeles	
Angel Step Inn (323) 780-7285, Los Angeles	
STAR House (women and children) (323) 461-4118	
Sojourn (310) 264-6644 X235, Los Angeles	
1736 Family Crisis Center (213) 745-6434, Redondo Beach	
Good Shepherd (323) 737-6111, Los Angeles	
Haven Hills (818) 887-7481, Canoga Park	
House of Ruth (909) 623-4364, Pomona	
Valley Oasis (800) 945-6736, Antelope Valley	
Financial Assistance:	
L.A. County Department of Public Social Services (General Relief, CalWORKS, Medi-Cal etc.) (866) 613-3777	
Local Office: 11110 W Pico Blvd, Los Angeles 866-613-3777	
Medi-Cal (800) 541-5555	
Social Security Administration (SSI, SDI, SSDI) – 24-hour Info Line (800) 772-1213	
Local Office: 11500 W Olympic Blvd, Suite 300, Los Angeles 90064	
Relative Risks	
Estimated Per-Act Probability of Acquiring HIV From a Known HIV-Infected Source by Exposure Act	
Type of Exposure Risk per 10,000 Exposures	
Parenteral	
Blood Transfusion 9,000	
Percutaneous ([[Needle Stick]]) 30	
Sexual	
Receptive anal intercourse 138	
Insertive anal intercourse 11	
Receptive penile-vaginal intercourse 8	
Insertive penile-vaginal intercourse 4	
Receptive oral intercourse low	
Insertive oral intercourse low	
Other	
Biting Negligible	
Spitting Negligible	
Throwing body fluids Negligible	
(including semen or saliva)	
http://www.cdc.gov/hiv/law/transmission.htm.	
Factors that increase the risk of HIV transmission include early and late-stage [[HIV (Human Immunodeficiency Virus)]] and a high level of HIV in the blood. Factors that reduce the risk of HIV transmission include low level of HIV in the blood and the use of ART.	
Rationale	
Several clinical studies have demonstrated that HIV transmission can be significantly reduced by the post-exposure administration of [[Anti-Retroviral Therapy]] agents. A dramatic decline in [[Vertical Transmission]] was observed in the AIDS Clinical Trial Group (ACTG) 076 study,1 in which pregnant women and their newborns received monotherapy with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] ([[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]), and in the HIVNET 012 study,2 in which single-dose [[NVP (Nevirapine, VIRAMUNE)]] was compared with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]. A CDC retrospective [[Case Control]] study3 of [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] use after occupational HIV exposure in healthcare workers (HCWs) showed an 81% reduction in risk of [[HIV (Human Immunodeficiency Virus)]] in persons who received [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]].	
Because the ultimate goals of PEP are to maximally suppress any limited viral replication that may occur and to shift the biologic advantage to the host cellular immune system to prevent or abort early infection, the Committee recommends the use of a three-drug PEP regimen for all significant risk exposures.	
[[TODO]]
HP
Date of Note:
Chief Complaint:
History of Present Illnesses:
Past Medical History:
Allergies:
Medications:
Past Surgical History:
Social History:
[[ROS (Review Of System(s))]]: as above
Family History:
[[PE (Physical Exam(ination))]]:
Vital Signs
Temp / HR / RR / BP / O2 Sat
/ / / /
GEN: NAD, Laying Comfortably in bed
HEENT: PERRLA, no jaundice
CV: rrr, no mrg, +S1, S2
PULM: CTAB, no crackles, [[Wheez(-e -es; -ing)]], rales
ABD: soft, NTND, no rebound, no guarding
EXT: 2+ peripheral pulses. No edema b/l.
SKIN: no petechiae, no rash
NEURO: A&O x 3.
GU/Pelvic/rectal: deferred
Test Results:
Labs
BMP
Na / K / Cl / [[HCO3- (Bicarbonate (22-28 mEq/L))]] / BUN / Cr < Glu
/ / / / / <
CBC
WBC > Hgb / Hct < Plts
> / <
LFTs
Albumin / Tot Protein / D. Bili / T. Bili / AST / ALT < [[ALP (Alk-Phos; Alkaline Phosphatase)]]
/ / / / / <
IMAGING
Assessment and Plan:
yo M/F with PMH * presents with
# FEN/GI: regular diet
# [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]] PPX: [[Heparin]] [[SubQ (Subcutaneous)]]
# Code Status: FULL CODE
# Dispo: Pending medical work-up
# Emergency Contact:
[ ] [[Central Line]], [[PICC (Peripherally Inserted Central Catheter)]], or dialysis catheter present and indicated
PLEASE SEE ATTENDING ADDENDUM
DISCUSSED WITH DOCTOR: Dr. Richman
Used Interpreter - Name:
Used HCN - Interpreter ID #:
Interpretation language:
ABD Reassessment
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]].
AMA
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.
Discharge
Pt well appearing, nontoxic, af, HDS. Patient advised of exam and study findings Patient understands and agrees with the plan of discharge. Return precautions discussed. Patient verbalized full understanding. Patient comfortable going home.
EKG Normal
EKG: [[Normal Sinus Rhythm]], no TWI/ST changes, normal intervals, ***normal axis.
EKG syncope
EKG reviewed, no TWI/ST changes. No [[Dysrhythmia]]s. Low suspicion for [[WPW (Congenital Pre-Excitation Syndrome; Wolff-Parkinson-White)]], [[QT Interval (Segment) Prolongation]], [[HOCM (Hypertrophic Obstructive Cardiomyopathy)]], [[Brugada Syndrome]].
ETOH reassess/discharge
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient with increased lucidity, tolerating PO, interactive with staff. [[Hemodynamic(ally) (Stability, Stable)]].
Trialed gait after several hours of observation in the ED with improvement in mental status to baseline and with stable gait. Cautious return precautions discussed w/ full understanding.
FAST Neg
FAST negative: Cardiac motion present. No pericardial fluid . No free fluid RUQ, LUQ or in pelvis.
Headache
Patient headache has improved after medication. No focal neurological deficits.
Reassess
Patient reassessed and re-examined. No additional findings on exam or complaints. Pt well-appearing.
Signout
Patient Signed out to Dr.
Pending items
Likely dispo
ALLERGIC RASH – LOW RISK
This patient presents with symptoms consistent with acute [[Hypersensitivity]] reaction, likely acute allergic reaction. Presentation not consistent with acute [[Anaphylaxis]] (lack of pulmonary, dermatologic, cardiovascular or GI symptoms, lack of [[Hypotensive]] or exposure to known allergen), [[Angioedema]], [[Serum Sickness]] (no recent drug exposure, lacks fevers, arthralgias), ingestion of [[Preformed Toxin]]. No evidence of airway compromise or shock at this time. Plan to treat for an allergic reaction with H1/[[H2 Blocker]], [[Steroid]]. No indication for [[Epinephrine (Adrenaline)]] at this time.* Given lack of respiratory symptoms, no indication for EpiPen Rx.*
Plan: ***H1/[[H2 Blocker]], [[Steroid]], close [[Hemodynamic Monitoring]], serial reassessment
[[AMS (Altered Mental Status)]] – GENERAL
This is a @[email protected] @[email protected] presenting with [[AMS (Altered Mental Status)]], concerning for *. The differential includes toxic metabolic etiologies such as [[Electrolyte Disturbance]]s (Na/Ca), [[↓Glucose↓]], and [[Uremia]]; acidosis states, infection (i.e. Sepsis); toxidromes of intoxication or withdrawal, [[PO2 <8 kPa (Hypox(a)emia)]] or [[Hypercarbia]], [[Liver Disease]] or failure causing [[Hepatic [[Encephalopathy (Altered (Level Of) Consciousness)]]]], endocrine emergencies (hyper/[[Hypothyroid(ism)]], [[Hypoadrenalism ((Acute; Severe) (Adrenal Insufficiency; ((Addisonian; Adrenal) Crisis))]]), seizure, trauma, intracranial bleeds or [[Ischemic Stroke]]. Given this wide differential, will send basic labs and lytes to evaluate for metabolic causes, FSBS, LFTs,, TSH, *CT head, *[[Blood Gas]]. *LP?/abx?
AMA DOCUMENTATION
This patient has elected to leave [[AMA (Against Medical Advice)]]. In my opinion, the patient has capacity to leave AMA. The patient is clinically sober, free from distracting injury, appears to have intact insight and judgment and reason, and in my opinion has capacity to make decisions. I explained to the patient that his symptoms may represent *** and the patient verbalized understanding of my concerns.
I had a discussion with the patient about their workup and results, and that they may still have * despite *. I informed the patient that the next step in diagnosis and treatment would be *, and they verbalized understanding of this as well. I explained the risks of leaving without further workup or treatment, which included reasonably foreseeable complications such as death, serious injury, permanent disability, and *. I also offered alternatives to departing AMA such as assigning the patient a different provider or an alternate workup pathway.
The patient is refusing any further care, specifically *, and is leaving [[AMA (Against Medical Advice)]]. I am unable to convince the patient to stay. I have asked them to return as soon as possible to complete their evaluation, and also explained that they were welcome to return to the ER for further evaluation whenever they choose. I have asked the patient to follow up with their primary doctor as soon as possible. I have answered all their questions. Patient signed*did not sign AMA paperwork.
AMA DOCUMENTATION
MDM
This patient has elected to leave against medical advice. In my opinion, the patient has capacity to leave AMA. The patient is clinically sober, free from distracting injury, appears to have intact insight and judgment and reason, and in my opinion has capacity to make decisions. I explained to the patient that his symptoms may represent *** and the patient verbalized understanding of my concerns.
I had a discussion with the patient about their workup and results, and that they may still have * despite *. I informed the patient that the next step in diagnosis and treatment would be *, and they verbalized understanding of this as well. I explained the risks of leaving without further workup or treatment, which included reasonably foreseeable complications such as death, serious injury, permanent disability, and *. I also offered alternatives to departing AMA such as assigning the patient a different provider or an alternate workup pathway.
The patient is refusing any further care, specifically *, and is leaving [[AMA (Against Medical Advice)]]. I am unable to convince the patient to stay. I have asked them to return as soon as possible to complete their evaluation, and also explained that they were welcome to return to the ER for further evaluation whenever they choose. I have asked the patient to follow up with their primary doctor as soon as possible. I have answered all their questions. Patient signed*did not sign AMA paperwork.
April 18, 2018 Tagged AMA, capacity, MDM Leave a comment
AMS – HEPATIC [[Encephalopathy (Altered (Level Of) Consciousness)]]
This is a @[email protected] @[email protected] with a presentation consistent with acute [[Hepatic [[Encephalopathy (Altered (Level Of) Consciousness)]]]]. Exam notable for stigmata of [[Cirrhosis]] and [[PH (Portal [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]])]]. Likely precipitant: increased ammonia levels (GIB // excess protein // infection // electrolyte and/or acid base disturbance// [[Constipation]]) // dehydration (vomiting, diuretic use) // medication induced (opioids, [[Benzodiazepine Overdose]] or withdrawal // ETOH use.*** Low suspicion for acute GIB, including evidence of life threatening [[Hemorrhage]]. Low suspicion for acute infection including SBP (no fevers, [[Abdominal Pain]]). Presentation not consistent with other acute, emergent causes of [[AMS (Altered Mental Status)]] (including but not limited to renal failure, ICH) at this time.
Plan: labs, LFTs, ammonia level, PT/INR, UA, CXR, CT brain*, diagnostic paracentesis*, serial reassessment
[[Back Pain (Dolor)]] – LOW RISK
This patient presents with [[Back Pain (Dolor)]] most consistent with ***. Differential diagnoses includes lumbago versus [[MSK (Musculoskeletal)]] spasm / strain versus [[Lumbar Radiculopathy]].
No [[Back Pain (Dolor)]] [[Red Flag(s)]] on history or physical.
Presentation not consistent with malignancy (lack of history of malignancy, lack of [[B (Systemic) Symptoms]]), fracture (no trauma, no [[Bony Tenderness]] to palpation), [[CES (Cauda Equina Syndrome)]] (no bowel or [[Urinary Incontinence]]/retention, no [[Saddle Anesthesia]], no distal weakness), AAA, viscus perforation , [[PE (Pulmonary [[Embolism]]/ous)]], [[Renal Colic]], [[Pyelonephritis]] (afebrile, no CVAT, no urinary symptoms).
Given the clinical picture, no indication for imaging at this time.
Plan: [[Pain Control]], supportive care, reassess
CAPACITY ASSESSMENT
YES:
Capacity Assessment: In my medical opinion, this patient has capacity to make medical decisions. The patient has the ability to communicate their choice to me and others, understands the information relevant to this decision, appreciates the situation itself and the consequences inherent to their choice, and can logically explain their rationale for their decision.
NO:
In my medical opinion, this patient does NOT have capacity to make a medical decision regarding ***, because
a. The patient is unable to communicate a choice.
b. The patient is unable to understand the relevant information
c. The patient is unable to appreciate a situation and its consequences
d. The patient is unable to reason rationally.
April 18, 2018 Tagged AMA, capacity, MDM Leave a comment
CAPACITY ASSESSMENT
MDM
YES:
Capacity Assessment: In my medical opinion, this patient has capacity to make medical decisions. The patient has the ability to communicate their choice to me and others, understands the information relevant to this decision, appreciates the situation itself and the consequences inherent to their choice, and can logically explain their rationale for their decision.
NO:
In my medical opinion, this patient does NOT have capacity to make a medical decision regarding ***, because
a. The patient is unable to communicate a choice.
b. The patient is unable to understand the relevant information
c. The patient is unable to appreciate a situation and its consequences
d. The patient is unable to reason rationally.
April 18, 2018 Tagged AMA, capacity, MDM Leave a comment
CDC Recommendations (2013)
* Kuhar DT, Henderson DK, Struble KA, et al. Updated U.S. Public Health Service guidelines for the management of [[Occupational Exposure]]s to [[HIV (Human Immunodeficiency Virus)]] and recommendations for postexposure [[Prophylaxis]]. Infect Control Hosp Epidemiol 2013;34: 875-892. Available at: http://stacks.cdc.gov/view/cdc/20711
Indications: Percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or potentially infectious body fluids, such as semen, vaginal secretions, and visibly [[Bloody Fluid]]s and reasonable suspicion that the source patient is HIV-infected.
Source Testing:
Although concerns have been expressed regarding HIV-negative sources being in the window period for seroconversion, no case of transmission involving an exposure source during the window period has been reported in the United States. Rapid HIV testing of source patients can facilitate making timely decisions regarding use of HIV PEP after [[Occupational Exposure]]s to sources of unknown HIV status.
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Raltegravir 400 mg PO twice daily
Duration of PEP: 4 weeks
HIV Antibody Testing of Healthcare Worker
Baseline
6 weeks post-exposure
12 weeks post-exposure
6 months post-exposure
Alternatively, if the clinician is certain that a fourth-generation antibody/antigen combination assay is being used, then HIV testing could be performed at baseline, 6 weeks, and concluded at 4 months post-exposure.
PEP should be initiated as soon as possible, preferably within hours rather than days of exposure. Initiation of PEP should not be delayed while awaiting the results of a source patient’s HIV test, nor should it be delayed during consultation with experts to determine ideal PEP regimens.
CHEST PAIN – ADMIT (HIGH RISK)
This patient presents with chest pain, with a history suggestive of *. No evidence of [[Volume Overload]] or shock on exam. EKG without signs of active [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]. EKG without evidence of STEMI. Low suspicion for acute PE (Wells low risk *), [[PTX (Pneumothorax)]], [[Thoracic Aortic Dissection]], cardiac effusion / tamponade. Overall, ACS is being considered given higher risk features, *, history & physical. HEART score: *.
Patient will require admission for inpatient risk stratification and possible [[Provocative Testing]].
Plan: [[Cardiac Monitor]], EKG, troponins,CXR, ASA, [[Heparin]]*, [[Pain Control]], reassess, Cardiology consult*
CHEST PAIN – ADMIT (HIGH RISK)
MDM
This patient presents with chest pain, with a history suggestive of *. No evidence of [[Volume Overload]] or shock on exam. EKG without signs of active [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]. EKG without evidence of STEMI. Low suspicion for acute PE (Wells low risk *), [[PTX (Pneumothorax)]], [[Thoracic Aortic Dissection]], cardiac effusion / tamponade. Overall, ACS is being considered given higher risk features, *, history & physical. HEART score: *.
Patient will require admission for inpatient risk stratification and possible [[Provocative Testing]].
Plan: [[Cardiac Monitor]], EKG, troponins,CXR, ASA, [[Heparin]]*, [[Pain Control]], reassess, Cardiology consult*
January 3, 2018 Tagged acs, admit, cardiac, chest pain, MDM, nstemi Leave a comment
[[CHF (Congestive v[[HF (Heart Failure)]])]] EXACERBATION – ADMIT
Uncategorized
This patient presents with signs and symptoms consistent with an acute exacerbation of chronic [[CHF (Congestive v[[HF (Heart Failure)]])]], likely due to ***. Differential diagnosis includes alternate cardiopulmonary causes such as [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]], PE, [[PTX (Pneumothorax)]], and pneumonia, as well as other causes of [[Dyspnea]] such as [[Asthma]]/RAD, COPD, [[APE; FPE ((Flash; Acute) PE (Pulmonary Edema))]], [[Dysrhythmia]] but these are less likely. Patient is generally [[Hemodynamic(ally) (Stability, Stable)]].
Plan: labs, EKG, CXR, troponin, [[IV (Intravenous)]] [[Diuresis]], and electrolyte repletion. Will require admission for IV diuretics and medical optimization.
October 26, 2018 Leave a comment
[[CHF (Congestive v[[HF (Heart Failure)]])]] EXACERBATION – ADMIT
Uncategorized
This patient presents with signs and symptoms consistent with an acute exacerbation of chronic [[CHF (Congestive v[[HF (Heart Failure)]])]], likely due to ***. Differential diagnosis includes alternate cardiopulmonary causes such as [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]], PE, [[PTX (Pneumothorax)]], and pneumonia, as well as other causes of [[Dyspnea]] such as [[Asthma]]/RAD, COPD, [[APE; FPE ((Flash; Acute) PE (Pulmonary Edema))]], [[Dysrhythmia]] but these are less likely. Patient is generally [[Hemodynamic(ally) (Stability, Stable)]].
Plan: labs, EKG, CXR, troponin, [[IV (Intravenous)]] [[Diuresis]], and electrolyte repletion. Will require admission for IV diuretics and medical optimization.
[October 26, 2018](https://natedotphrase.com/2018/10/26/[[CHF (Congestive v[[HF (Heart Failure)]])]]-exacerbation-admit/) [Leave a comment](https://natedotphrase.com/2018/10/26/[[CHF (Congestive v[[HF (Heart Failure)]])]]-exacerbation-admit/#respond)
[[CHF (Congestive v[[HF (Heart Failure)]])]] WITH SHOCK – ADMIT
MDM
This patient with a hx of *[[CHF (Congestive v[[HF (Heart Failure)]])]] presents with acute [[SOB (Shortness of Breath)]] and [[PE (Peripheral Edema)]], most consistent with [[ADHF (Acute DHF (Decompensated [[HF (Heart Failure)]]))]] and concerning for [[Cardiogenic Shock]]. Likely etiology is medication non-compliance // dietary indiscretion // HTN // infection // fluid overload // anemia //alcohol intoxication // thyroid disease.* I considered ACS as a possible etiology but think this less likely. EKG without overt evidence of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]]. Other acute, emergent etiologies of [[SOB (Shortness of Breath)]] are unlikely at this time.
Given tenuous systolic function and [[Hypotensive]], plan includes starting ionotrope such as [[Dobutamine (DOBUTREX, INOTREX, GENERIC)]]
#ERROR!
(i.e. Dopamine, [[Levophed]]).
Will give O2; would like to avoid utilizing [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] or intubation due to tenuous preload status.
Will require admission for acute management of [[ADHF (Acute DHF (Decompensated [[HF (Heart Failure)]]))]].
Plan: labs, troponin, [[BNP; BNF (Brain Natriuretic (Factor; Peptide))]], EKG, CXR, BUS, [[Vasopressor]], Cardiology consult***
[January 3, 2018](https://natedotphrase.com/2018/01/03/mdm-[[CHF (Congestive v[[HF (Heart Failure)]])]]-with-shock-admit/) Tagged admit, cardiac, [[CHF (Congestive v[[HF (Heart Failure)]])]]](https://natedotphrase.com/tag/[[CHF (Congestive v[[HF (Heart Failure)]])]]/), MDM [Leave a comment](https://natedotphrase.com/2018/01/03/mdm-[[CHF (Congestive v[[HF (Heart Failure)]])]]-with-shock-admit/#respond)
[[CHF (Congestive v[[HF (Heart Failure)]])]] – HYPERTENSIVE PULM EDEMA
MDM
This is a @[email protected] @[email protected] patient with history of * sided, *olic [[CHF (Congestive v[[HF (Heart Failure)]])]], presenting with likely [[ADHF (Acute DHF (Decompensated [[HF (Heart Failure)]]))]] and *[[PE (Pulmonary Edema)]]. The etiology of his decompensation is *unclear but is likely due to *. Alternative etiologies I considered include cardiac (ACS, valvular disease, [[Arrhythmia (Abnormal Rhythm)]], [[Myocarditis]]/[[Endocarditis]], dissection), respiratory (COPD, PE, or PNA), medication noncompliance or dietary indiscretion, alcohol or drug abuse, endocrine ([[Graves Disease (Thyrotoxicosis)]]), and anemia*. ***I considered ACS as a possible cause of the exacerbation but think this is unlikely given history and EKG without overt evidence of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]]. Other acute, emergent etiologies of [[SOB (Shortness of Breath)]] unlikely.
I plan for afterload reduction with nitrates given [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] and possibly ACEi. Given respiratory status will also consider starting [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]]. Will start [[Diuresis]] after nitrate administration. The patient will require admission for acute management of [[ADHF (Acute DHF (Decompensated [[HF (Heart Failure)]]))]].
Plan: labs, troponin, [[BNP; BNF (Brain Natriuretic (Factor; Peptide))]], EKG, CXR, BUS, nitrates/diuretics, admission
__[January 3, 2018](https://natedotphrase.com/2018/01/03/[[CHF (Congestive v[[HF (Heart Failure)]])]]-hypertensive-pulm-edema-mdm/) Tagged admit, cardiac, [[CHF (Congestive v[[HF (Heart Failure)]])]]](https://natedotphrase.com/tag/[[CHF (Congestive v[[HF (Heart Failure)]])]]/),
[[Hypertensive Emergency]]
](https://natedotphrase.com/tag/hypertensive-emergency/), MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[CHF (Congestive v[[HF (Heart Failure)]])]]-hypertensive-pulm-edema-mdm/#respond)__
[[Constipation]] – GI
MDM
This is a AGE YEAR presenting with symptoms consistent with [[Constipation]]. Differential diagnosis includes ***. Presentation not consistent with acute bowel obstruction caused by tumor, stricture, hernia, adhesion, volvulus or fecal impaction. Low suspicion for etiology related to new medications including opiates, [[Anti-Psychotic]], [[Anti-Cholinergic]]s, [[Antacid]], or antihistamines. Presentation not consistent with acute [[Anorectal]] disorders. Low suspicion for chronic causes of [[Constipation]] including [[Hypothyroid(ism)]] or [[Electrolyte Disorders]]. Presentation not consistent with other acute, emergent causes of [[Constipation]] at this time.
Plan: supportive care, Rx *, XR abdomen*, electrolytes***
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Constipation]]-gi-mdm/) Tagged [[Constipation]]](https://natedotphrase.com/tag/[[Constipation]]/), gi, low risk, MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[Constipation]]-gi-mdm/#respond)
[[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]] – ADMIT
MDM
This patient presents with symptoms most consistent with an acute [[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]]. These [[Constellation]] of symptoms are similar to prior flares without overt deviations from normal exacerbations. The likely precipitant is acute respiratory infection // weather change or air quality // recent [[Beta (Adrenergic) Blocker]] or opiate use.*** Low suspicion for alternate etiologies such as [[PTX (Pneumothorax)]], acute PE. Presentation not consistent with other acute cardiopulmonary causes including ACS / [[CHF (Congestive v[[HF (Heart Failure)]])]] / cardiac effusion.
Pseudomonas risk factors: recent hospitalization // frequent antibiotic treatment // severe COPD // previously isolated Pseudomonas.* Plan to maintain [[SaO2 (Oxygen Saturation)]] ~90-94% with [[Supplemental O2 (Oxygen)]]. Based on current presentation, including work of breathing, patient will need [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] ([[CPAP (Continuous Positive Airway Pressure)]]/BiPAP) // will not need [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] at this time. Plan for trial of [[Duoneb]]s, [[Steroid]]. Antibiotics *indicated given purulent sputum // increased sputum production // trial of [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] // No indication for antibiotic treatment at this time.*** Will evaluate for other acute cardiopulmonary processes with a CXR.
Anticipate hospitalization given marked increase in symptoms // significant co-morbidities and age // new [[Arrhythmia (Abnormal Rhythm)]].***
Plan: [[Supplemental O2 (Oxygen)]] (goal [[SaO2 (Oxygen Saturation)]] ~90-94%), [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]]*, [[Duoneb]]s, [[Steroid]], antibiotics*, CXR***, serial reassessment
January 3, 2018 Tagged admit, copd, MDM, SOB Leave a comment
COUGH, SIMPLE – LOW RISK
MDM
This patient presents with [[Acute Cough]], most consistent with *. Differential diagnosis includes *. Presentation not consistent with acute [[Bacterial Pneumonia]], influenza, [[Asthma]], transient airway hyperresponsiveness. Presentation not consistent with chronic causes of cough (including [[GERD (Gastroesophageal Reflux Disease)]], [[Asthma]], post[[Nasal Discharge]], medication side effect, [[CHF (Congestive v[[HF (Heart Failure)]])]], [[Carcinoma Of The Lung]] or mass).
Plan: ***CXR, supportive care, reassess
January 3, 2018 Tagged cough, low risk, MDM Leave a comment
DKA – ADMIT
This patient presents with [[Hyperglycemic]] and symptoms concerning for DKA. Differential diagnosis includes other metabolic causes of [[Hyperglycemic]] such as [[HHS (Hyperglycemic Hyperosmolar (Syndrome; State))]], worsened diabetes or medication noncompliance. Considered possible causes of DKA to include infection ([[Pancreatitis]], UTI, pneumonia), [[Infarction]] / [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]] ([[ACS (Acute Coronary Syndrome)]], cerebral vascular accident), medication non-compliance with [[INS (Insulin)]] therapy, [[Illicit (Substance; Drug) (Use)]] abuse, iatrogenic (including prescription medications and drug-drug interactions), idiopathic causes. Most likely etiology at this time is ***. Plan to treat the [[Hyperglycemic]] as below while simultaneously evaluating and treating potential underlying etiologies.
Plan:
POC [[BGM (Blood Glucose (Level) Monitoring)]] (Q1H), BMP (Q2H), [[Blood Gas]], UA, serum ketones, CBC, LFTs / lipase, infectious workup (lactate/blood cultures, [[Chest X-Ray]])***, IVF, IV [[INS (Insulin)]] therapy, serial reassessment, admission for treatment of [[Hyperglycemic]]
[[Dyspnea]] – GENERAL
MDM
This patient presents with [[Dyspnea]], most likely secondary to *. Differential diagnosis includes *. Presentation not consistent with acute cardiac etiologies to include ACS (HEART score *), [[CHF (Congestive v[[HF (Heart Failure)]])]], [[Pericardial Effusion]] / tamponade . Presentation not consistent with acute respiratory etiologies to include acute PE (Wells low risk *), [[PTX (Pneumothorax)]] , [[Asthma]], [[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]], allergic etiologies, or infectious etiologies such as PNA. Presentation also not consistent with non-cardiopulmonary causes to include toxidromes, metabolic etiologies such as acidemia or electrolyte derangements, sepsis, neurologic causes (i.e. demyelinating diseases).
Plan: [[Supplemental O2 (Oxygen)]], [[NIPPV (Non-Invasive PPV (Positive Pressure Ventilation))]] ***, CXR, labs, troponin, close [[Hemodynamic Monitoring]], serial reassessment
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Dyspnea]]-general/) Tagged [[Dyspnea]]](https://natedotphrase.com/tag/[[Dyspnea]]/), general, MDM, pulm, SOB [Leave a comment](https://natedotphrase.com/2018/01/03/[[Dyspnea]]-general/#respond)
[[Epigastric (Abdominal) Pain]] – LOW RISK
MDM
Presentation consistent with acute [[Epigastric (Abdominal) Pain]]. Differential diagnosis includes ***. Abdominal exam without peritoneal signs. No evidence of [[Acute Abdomen]] at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng [[Acute Cholecystitis]]), [[Acute Pancreatitis]], PUD (including perforation), acute infectious processes (pneumonia, [[Hepatitis]], [[Pyelonephritis]]), atypical [[Appendicitis]], vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.
Plan: labs, UA, GI cocktail, [[RUQ U/S (RUQ (Right Upper Quadrant) U/S ([[US(G) (Ultra(sound; -sonogram; sonography))]]))]] ***, serial reassessment
-Courtesy Adam Evans
January 3, 2018 Tagged [[Abdominal Pain]]](https://natedotphrase.com/tag/abdominal-pain/), adult, [[[Gastritis]]](https://natedotphrase.com/tag/[[Gastritis]]/), MDM Leave a comment
[[Gallstone (Cholelithiasis)]] – LOW RISK
This patient presents with [[Abdominal Pain]], most consistent with acute, uncomplicated [[Biliary Colic]].
Bedside [[US(G) (Ultra(sound; -sonogram; sonography))]] demonstrating visible [[Gallstone (Cholelithiasis)]] without overt signs of [[Cholecystitis]] (thickened GB wall, [[Pericholecystic Fluid]], CBD [[Dilatation]]).
Patient is afebrile and not jaundiced or altered, lowering my suspicion for [[Cholangitis]].
Presentation not consistent with [[Acute Pancreatitis]] at this time.
Low suspicion for bowel obstruction, viscus perforation, vascular catastrophe, or atypical [[Appendicitis]].
Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.
Plan for formal [[RUQ U/S (RUQ (Right Upper Quadrant) U/S ([[US(G) (Ultra(sound; -sonogram; sonography))]]))]] to evaluate [[Gallbladder]] pathology.***
Plan: labs, LFTs, lipase, [[RUQ U/S (RUQ (Right Upper Quadrant) U/S ([[US(G) (Ultra(sound; -sonogram; sonography))]]))]]***, [[Pain Control]], supportive care, serial reassessment
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Gallstone (Cholelithiasis)]]-mdm-lo-risk/) Tagged biliary, [[[Gallstone (Cholelithiasis)]]](https://natedotphrase.com/tag/[[Gallstone (Cholelithiasis)]]/), gi, low risk, MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[Gallstone (Cholelithiasis)]]-mdm-lo-risk/#respond)
[[Gastroenteritis]] – LOW RISK
MDM
This patient presents with *** nausea, vomiting & [[Diarrhea]].
Differential diagnoses includes possible acute [[Gastroenteritis]].
Abdominal exam without peritoneal signs.
Currently ***[[(Iso;Eu)volemia]] without evidence of dehydration.
No evidence of surgical abdomen or other acute medical emergency including bowel obstruction, viscus perforation, vascular catastrophe, atypical [[Appendicitis]], [[Acute Cholecystitis]] at this time.
Presentation not consistent with other acute, emergent causes of vomiting / [[Diarrhea]] at this time.
No indication for abdominal imaging.
Plan: supportive care, oral // IV rehydration ***, serial abdominal exam, reassess
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Gastroenteritis]]-mdm-lo-risk/) Tagged [[[Gastroenteritis]]](https://natedotphrase.com/tag/[[Gastroenteritis]]/), gi, low risk, MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[Gastroenteritis]]-mdm-lo-risk/#respond)
GENERAL [[Abdominal Pain]] – LO RISK
MDM
Differential diagnosis includes: ***.
Abdominal exam without peritoneal signs. No evidence of [[Acute Abdomen]] at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng [[Acute Cholecystitis]]), [[Acute Pancreatitis]], PUD (including perforation), acute infectious processes (pneumonia, [[Hepatitis]], [[Pyelonephritis]]), [[Acute Appendicitis]], vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.
Plan: labs, UA, CT AP***, [[Pain Control]], serial reassessment
January 3, 2018 Tagged [[Abdominal Pain]]](https://natedotphrase.com/tag/abdominal-pain/), MDM Leave a comment
HOMELESSNESS DOCUMENTATION – CA SB 1152
DC, MDM
I have provided a medical screening examination and evaluation.
The patient is clinically stable for discharge. I have communicated post-discharge medical needs to the patient and the patient has been provided with or offered the following:
Meal
Weather appropriate clothing
Prescription or adequate supply of medication from hospital outpatient pharmacy
Referral to outpatient clinic for infectious disease screening
Vaccines appropriate to the patient’s presenting medical condition
Transportation has been arranged to patient’s post discharge destination.
December 31, 2018 1 Comment
HOMELESSNESS DOCUMENTATION – CA SB 1152
DC, MDM
I have provided a medical screening examination and evaluation.
The patient is clinically stable for discharge. I have communicated post-discharge medical needs to the patient and the patient has been provided with or offered the following:
Meal
Weather appropriate clothing
Prescription or adequate supply of medication from hospital outpatient pharmacy
Referral to outpatient clinic for infectious disease screening
Vaccines appropriate to the patient’s presenting medical condition
Transportation has been arranged to patient’s post discharge destination.
December 31, 2018 1 Comment
[[Hyperglycemic]] – LO RISK
This patient is a @[email protected] @[email protected], presenting with apparent acute [[Hyperglycemic]]. Differential diagnosis includes ***. Considered DKA versus [[HHS (Hyperglycemic Hyperosmolar (Syndrome; State))]], sepsis as possible etiologies of the patient’s current presentation. However, given the current history & physical, including current glucose level, the current presentation is consistent with acute, asymptomatic [[Hyperglycemic]]. Plan to treatment supportively. No indication for further workup at this time.
Plan: supportive care, serial POC [[BGM (Blood Glucose (Level) Monitoring)]], labs***, serial reassessment
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Hyperglycemic]]-lo-risk/) Tagged diabetes, dka, [[HHS (Hyperglycemic Hyperosmolar (Syndrome; State))]]](https://natedotphrase.com/tag/[[HHS (Hyperglycemic Hyperosmolar (Syndrome; State))]]/), [[Hyperglycemic]]](https://natedotphrase.com/tag/[[Hyperglycemic]]/), low risk, MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[Hyperglycemic]]-lo-risk/#respond)
[[↓Glucose↓]] – GENERAL
This patient presents with symptoms and labs consistent with acute [[↓Glucose↓]], most likely due to *. Differential diagnosis includes *. Considered other etiologies of acute [[↓Glucose↓]] to include drugs (anti-[[Hyperglycemic]]s, alcohol, [[Beta (Adrenergic) Blocker]], [[ACE-I (ACE (Angiotensin Converting Enzyme) Inhibitor)]], APAP) or drug related error (missed meal, incorrect dosing, intentional overdose), systemic illness (sepsis, [[ACS (Acute Coronary Syndrome)]], renal / [[(Liver; Hepatic) Failure]], [[Hypoadrenalism ((Acute; Severe) (Adrenal Insufficiency; ((Addisonian; Adrenal) Crisis))]]), malignancy, or post-op complications (i.e. Gastric bypass). Presentation not consistent with other acute, emergencies related to [[↓Glucose↓]].
Plan: serial POC glucose, [[↓Glucose↓]] protocol treatment per routine, labs***, consider observation/admission, serial reassessment
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[↓Glucose↓]]-general/) Tagged diabetes, [[↓Glucose↓]]](https://natedotphrase.com/tag/[[↓Glucose↓]]/), MDM [Leave a comment](https://natedotphrase.com/2018/01/03/[[↓Glucose↓]]-general/#respond)
LINKS AND ATTRIBUTION
Uncategorized
Ty Dot Phrase: tydotphrase.wordpress.com
An excellent, and more complete, list of dot phrases by a fellow co-resident. Also includes a large amount of educational pearls and high-risk diagnoses to consider.
Brian T.’s Templates: brianemr.blogspot.com/
A lengthy list of discharge instructions, albeit a little disorganized.
—–
All images obtained via FlatIcon with attributions below:
Intestine: Icons made by Kirill Kazachek from www.flaticon.com is licensed by CC 3.0 BY
Heart: Icons made by Freepik from www.flaticon.com is licensed by CC 3.0 BY
Baby: Icons made by Smashicons from www.flaticon.com is licensed by CC 3.0 BY
Uterus: Icons made by Roundicons from www.flaticon.com is licensed by CC 3.0 BY
Muscle: Icons made by Vectors Market from www.flaticon.com is licensed by CC 3.0 BY
Poison: Icons made by Freepik from www.flaticon.com is licensed by CC 3.0 BY
Psych: Icons made by Those Icons from www.flaticon.com is licensed by CC 3.0 BY
Kidneys: Icons made by Smashicons from www.flaticon.com is licensed by CC 3.0 BY
House: Vectors Market from www.flaticon.com is licensed by CC 3.0 BY
January 3, 2018 Leave a comment
LOWER GIB – GENERAL
MDM
This patient presents with symptoms concerning for a lower [[Gastrointestinal Bleed]].
Differential diagnoses include [[Diverticulitis]] (most common cause) versus [[Hemorrhoid (Pile)]].
Less likely etiologies include angiodysplasia, cancer, IBD.
Presentation not consistent with [[Mesenteric [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] or [[Ischemic Colitis]], brisk or life threatening upper GIB as patient has no evidence of [[Hemorrhagic Shock]].
Plan to check labs to evaluate the extent of bleeding, including H/H.
Will consent patient for blood and transfuse to goal Hb of >7 if necessary.
No indication for abdominal imaging at this time.***
Plan: labs, LFTs, close [[Hemodynamic Monitoring]], serial reassessment, CT AP***
PANIC ATTACK – LOW RISK
MDM
This patient presents with symptoms consistent with acute anxiety reaction / panic attack. Low suspicion for acute cardiopulmonary process including ACS, PE, or [[Thoracic Aortic Dissection]]. Denies any ingestions or any other medical complaints. No evidence of [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Presentation not consistent with overt toxidrome, ingestion given history & physical. Presentation not consistent with organic or medical emergency at this time. No acute indication for psychiatric consultation (without SI/HI, AH/VH). Cautious return precautions discussed with full understanding.
Plan: Rx ***, Psych follow up PRN
January 3, 2018 Tagged low risk, MDM, panic attack, psych Leave a comment
[[Paresthesias]] – LO RISK
MDM
This * patient presents with [[Paresthesias]], most likely due to *. Differential diagnoses includes ***. Presentation not consistent with emergent neurologic etiologies to include brain / spinal cord nerve root or nerve problem given history & physical. Presentation not consistent with immune phenomenon to include GBS or vasculitis. Presentation not consistent with [[Toxins]] to include [[Botulism]], diptheria, tick-borne illnesses, [[Heavy Metal]] poisoning. Presentation not consistent with acute drug toxicity or metabolic issues.
Plan: labs*, CT brain*, supportive care, reassessment
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Paresthesias]]-lo-risk/) Tagged low risk, MDM, neuro, [[Numbness]]](https://natedotphrase.com/tag/[[Numbness]]/), [[[Paresthesias]]](https://natedotphrase.com/tag/[[Paresthesias]]/) [Leave a comment](https://natedotphrase.com/2018/01/03/[[Paresthesias]]-lo-risk/#respond)
PEDS COUGH – URI
Peds
* year old * presenting with cough. Patient is afebrile. Presentation consistent with uncomplicated viral URI given classic history and [[PE (Physical Exam(ination))]], positive sick contacts, and well-appearing child***. No warning signs of systemic infection (fevers, tachypnea) to suggest pneumonia, and lung sounds clear on exam. No [[Photophobia]] or neck stiffness/pain to suggest meningitis. No rash. No clinical evidence of dehydration and child is taking excellent PO and making multiple wet diapers per day. Patient has attentive parents and good follow up.
Plan: Discharge to home with strict return precautions, encourage PO hydration, return to ***clinic/ER in 48 hours if no improvement
January 2, 2018 Tagged cough, Peds, uri Leave a commen
PEDS – APPY RULE OUT
Peds
* is a *y/o child who presents with [[Abdominal Pain]], vomiting, anorexia, concerning for [[Appendicitis]].
Differential includes [[Gastritis]] or early [[Gastroenteritis]], although history suggests appy is at least equally likely.
[[Intussusception]], [[Meckel]]’s also a possibility but would be atypical given patient age.
Similarly volvulus or malrotation unlikely given otherwise well-appearing patient without peritonitic/rigid abdomen.
Unlikely to represent UTI given no [[Dysuria]], no [[Suprapubic Pain]].
Would be an atypical presentation of pneumonia and patient is normoxemic without [[Dyspnea]] or cough.
Low index of suspicion for *gynececological etiologies such as torsion, TOA, or ectopic given * OR *[[Testicular Torsion]], orchitis/[[Epididymitis]] given *.
Plan: ***
January 2, 2018 Tagged appenciditis, Peds Leave a comment
PEDS – [[Gastritis]] – NONTOXIC
Peds
* is a * y/o otherwise healthy *** with mid[[Epigastric (Abdominal) Pain]] worsened with eating, most consistent with [[Gastritis]]. Reassuring that his pain was relieved with OTC [[Antacid]]. Differential includes [[GERD (Gastroesophageal Reflux Disease)]], early [[Gastroenteritis]], PUD. Low suspicion for referred cardiac etiologies given age and lack of fmhx early heart disease. Denying chest pain. No infectious symptoms (tachypnea, fever/chills, etc) to suggest bacterial infection such as PNA or biliary tree infection. No urinary symptoms to suggest UTI, no RLQ or migratory pain or fever to indicate a concern for appy. No blood/mucus in stool to suggest invasive bacterial species. Otherwise well-appearing child, tolerating adequate PO and not dehydrated.
Plan: discharge to home with return precautions, encourage PO hydration,
***recommend OTC meds
such as [[ZanTAC (Ranitidine)]], tums
[January 2, 2018](https://natedotphrase.com/2018/01/02/peds-[[Gastritis]]-nontoxic/) Tagged [[[Gastritis]]](https://natedotphrase.com/tag/[[Gastritis]]/), Peds [Leave a comment](https://natedotphrase.com/2018/01/02/peds-[[Gastritis]]-nontoxic/#respond)
PEDS – GASTRO/AGE – NONTOXIC
Peds
This is a *** pt presenting with [[Abdominal Pain]], +fever, +[[Myalgia]], +[[Diarrhea]], and nausea most consistent with viral [[Gastroenteritis]].
***sick contacts with similar symptoms.
Differential includes invasive/toxic [[Diarrhea]], sepsis, influenza, along with the far less likely surgical etiologies such as volvulus, [[Appendicitis]], malro, and SBO.
No change in diet or abnormal exposures.
No known stagnant water exposure, recent camping/hiking.
No dietary history or bloody BM’s suggestive of B. Cereus, [[SA (S(taphylococcus) Aureus)]], or other invasive bacterial enteric pathogens.
Pt with good capillary refill (<2 sec), MMM, and is nonseptic in appearance.
Clinically is not dehydrated.
Unlikely to represent unusual manifestation of UTI, [[GERD (Gastroesophageal Reflux Disease)]], partial or complete anatomical obstruction, or other [[Acute Abdomen]].
Pt tolerating PO rehydration and is very well-appearing.
Plan: Presumed self-limited etiology; plan to DC home with return precautions and oral rehydration education.
January 2, 2018 Tagged AGE, gastro, [[[Gastroenteritis]]](https://natedotphrase.com/tag/[[Gastroenteritis]]/), Peds Leave a comment
PSYCH – BOARD & TRANSFER
MDM
This patient presents with symptoms consistent with an underlying psychiatric disorder, most likely *. Differential diagnosis includes *. Presentation not consistent with acute organic causes to include delirium, dementia or [[Drug Induced]] disorders (acute ingestions or withdrawal; no evidence of toxidrome). Given the H&P, I suspect this patient is *suicidal/homicidal/gravely disabled and will require psychiatric care. Will consult psychiatry to evaluate the patient for potential hold for *. Will also obtain labs for medical clearance.
Plan: labs*, EKG*, ASA/APAP levels*, ETOH level*, UDS*, ICON*, Psych consult, medical detainment, reassess
January 3, 2018 Tagged general, gravely disabled, homicidal, psych, suicidal Leave a comment
[[Rectal Bleed]] – LOW RISK
MDM
This patient has a presentation consistent with [[Rectal Bleeding]], most likely due to *. Differential diagnosis includes *. Low suspicion for [[Hemorrhoid (Pile)]] (external or internal, including [[Thrombosed Hemorrhoid]]s), [[Rectal Ulcer]] (HIV, syphilis, STI) or rectal [[Foreign Body]]. Presentation not consistent with other acute, emergent causes of upper or lower [[Gastrointestinal Bleeding]]. No evidence of [[Hemorrhagic Shock]].
Plan to check labs to evaluate the extent of bleeding, including H/H. No indication for abdominal imaging at this time.***
Plan: CBC, serial reassessment, PMD / GI referral
RLQ [[Abdominal Pain]]
MDM, Peds
This is a * with [[Right Lower Quadrant (RLQ) Pain]], most concerning for *. Differential diagnoses: [[Appendicitis]], ***. Abdominal exam without peritoneal signs. No evidence of [[Acute Abdomen]] at this time. Well appearing. Low suspicion for acute hepatobiliary disease (includng [[Acute Cholecystitis]]), acute infectious processes (pneumonia, [[Hepatitis]], [[Pyelonephritis]]), vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.
Plan: labs, UA, CT AP ***, [[Pain Control]], fluids, serial reassessment
January 3, 2018 Tagged [[Abdominal Pain]]](https://natedotphrase.com/tag/abdominal-pain/), MDM, rlq Leave a comment
RUQ [[Abdominal Pain]]
MDM
This is a @[email protected] @[email protected] with RUQ [[Abdominal Pain]], consistent with ***.
Differential diagnosis includes ***. Abdominal exam without peritoneal signs. No evidence of [[Acute Abdomen]] at this time. Well appearing. Moderate suspicion for acute hepatobiliary disease (includng [[Acute Cholecystitis]]). Less likely to represent [[Acute Pancreatitis]], PUD (including perforation), acute infectious processes (pneumonia, [[Hepatitis]], [[Pyelonephritis]]), atypical [[Appendicitis]], vascular catastrophe, bowel obstruction or viscus perforation. Presentation not consistent with other acute, emergent causes of [[Abdominal Pain]] at this time.
Plan: labs, UA, [[Pain Control]], [[RUQ U/S (RUQ (Right Upper Quadrant) U/S ([[US(G) (Ultra(sound; -sonogram; sonography))]]))]]***, serial reassessment
January 3, 2018 Tagged [[Abdominal Pain]]](https://natedotphrase.com/tag/abdominal-pain/), adult, [[Cholecystitis]]](https://natedotphrase.com/tag/[[Cholecystitis]]/), MDM, ruq Leave a comment
SEIZURE – GENERAL
MDM
This patient presents with symptoms consistent with acute seizure, most likely due to ***. I considered, but think less likely, secondary etiologies of epileptic [[Seizure]] to include drug / toxin etiologies (ETOH, stimulants, medication side effects), metabolic disturbances (glucose, Na), acute [[CNS (Central Nervous System) Infection]] (meningitis, [[Cerebritis; Encephalitis]], abscess), ICH / tumor / CVA. Presentation not consistent with non-epileptic type seizure to include syncope, neurologic etiologies ([[Vertebrobasilar Artery Insufficiency (VBI)]], movement disorder, [[Migraine (Headache)]]), impact seizure related to head trauma.
Plan: BZDs, labs*, CT brain*, seizure precautions, Neurology consult***, reassess
Pearls
Consider nonconvulsive status: persistent change in behavior that lasts 30 minutes after a seizure. Look for [[Positive Symptoms]] (twitching, eye deviation, jerking) and negative (aphasia, [[Catatonia (Syndrome)]], mutism). Many patients will just not respond. Think about this in head trauma patients with a decreased GCS and a negative initial CT. Also consider this in a “septic” altered patient with a borderline positive UA that isn’t that convincing.
January 3, 2018 Tagged general, MDM, neuro, seizure Leave a comment
STEVEN
DC, MDM, Peds, [[PE (Physical Exam(ination))]]](https://natedotphrase.com/tag/physical-exam/)
All updates courtesy Steve Lai and Brian Truong
MEDICAL [[Decision Making]]
MDMAlcohol
Patient presents with acute alcohol intoxication without evidence of co-ingestion or trauma per history and exam. Will observe patient in ED with frequent monitoring and reassessment. Plan to PO trial, reassess mental status, and assess gait when more stable. No evidence of withdrawal currently.
MDMAMA
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.
MDMANKLE
Neurovascularly intact. Query likely ankle sprain. Discussed conservative measures including rest, elevation, alternating application of ice, [[Pain Control]] and early ambulation as tolerated. No gross ankle instability. No evidence of maison-neue. Discussed follow up with PMD and given resources for ortho/sports medicine follow up as needed. Discussed strict return precautions for neurovascular insufficiency or need for repeat imaging/evaluation if pain not vastly improved in 5-7 days for possible occult fracture.
Patient with likely [[AOM (Acute Otitis Media)]] given history and exam. No overt e/o [[Mastoiditis]] or [[Malignant (Necrotizing) Otitis Externa]]. Nontoxic appearing with low suspicion for intracranial extension. Tolerating PO, low suspicion for concurrent serious bacterial infection. Will discharge home with [[Amoxicillin (MOXATAG)]] (high dose), auralgan, tylenol, follow up peds_. Cautious return precautions discussed w/ full understanding.
MDM[[Asthma]]
Patient presenting with [[SOB (Shortness of Breath)]]. Given exam and history, suspect likely acute [[Asthma Exacerbation]] without_ [[Status [[Asthma]]ticus]]. These [[Constellation]] of symptoms are similar to prior flares without overt deviations from normal exacerbations. Given clinical findings and history, low suspicion for pneumonia, [[PTX (Pneumothorax)]], or acute valvular failure. Patient with minimal risk factors for [[PE (Pulmonary [[Embolism]]/ous)]] and atypical ACS. As such, will trial bronchodilators, [[Steroid]], monitor respiratory status closely, reassess.
MDMBackPain
Patient presents with several days_ of [[Lower [[Back Pain (Dolor)]]]], atraumatic, afebrile. Given history and exam, suspect likely [[MSK (Musculoskeletal)]] etiology_. Nontoxic appearing and no overt risk factors for [[EDH (Epidural Hematoma)]] or abscess. No overt e/o [[CES (Cauda Equina Syndrome)]] or acute critical cord compression with nonfocal neuro exam. Neurovascularly intact distally. No e/o prostatitis or [[Fournier Gangrene]]. No peritoneal signs or [[Abdominal Pain]] on exam with low suspicion for AAA.
Patient presents with [[Abdominal Pain]] and [[US(G) (Ultra(sound; -sonogram; sonography))]] demonstrates visible [[Gallstone (Cholelithiasis)]]. Given exam and history, suspect likely uncomplicated_ [[Biliary Colic]]. Patient is afebrile without overt thickening of the [[Gallbladder]] wall, CBD dilation or [[Pericholecystic Fluid]] suggests the absence of [[Acute Cholecystitis]] or acute biliary obstruction. Patient is tolerating PO_ and suspicion for acute pancreatic involvement is low. After serial abdominal exams, history and observation, low suspicion at this time for other acute intraabdominal processes, including [[AA (Aortic Aneurysm)]], atypical [[Appendicitis]], [[Diverticulitis]], or bowel obstruction. Given resolution of pain and no peritoneal signs on serial exams, will discharge patient home with general surgery follow up and strict return precautions.
Wound inspected under direct bright light with good visualization.
Area with linear laceration across soft tissue through adipose without exposure of muscle belly or tendon_.
No overt [[Foreign Body]].
Area hemostatic.
Neurovascular exam congruent with above.
Area extensively irrigated with sterile [[0.9% NS; NaCl (Normal Saline; [[Na+ (Sodium; 135-145 mEq/L)]] Cl- (Chloride (95-105))]] under pressure.
Laceration repaired in simple fashion as below (please see procedure note for further details)_.
Patient tolerated procedure well and neurovascular exam intact and unchanged post repair with intact distal pulses and cap refill_.
Cautious return precautions discussed w/ full understanding.
[[Wound Care]] discussed.
Prompt follow up with primary care physician discussed and return for suture removal.
history of [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] presents for [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] with SBP _ sent in by PMD with concern for possible [[Pre-Eclampsia]]. Of note, patient without severe range BP in ED. Patient without neuro or ocular concerns at this time. No RUQ and no frank proteinuria. No seizure activity and without cardiothoracic symptoms.. Benign abdominal exam and non-focal neuro exam. Labs largely reassuring_. Therefore, given history and exam, low suspicion at this time for [[Fulminant]] [[Pre-Eclampsia]] requiring admission. No overt evidence of HELLP, acute [[Cholestasis]] of pregnancy, or eclampsia at this time. Discussed case with OB and after evaluation, will _. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician/OB arranged and discussed_.
Patient presenting with [[Constellation]] of symptoms concerning for vitreous [[Hemorrhage]] vs [[Retinal Detachment]]. Not contact lens wearer_. No prior ocular history_. Patient is headache free and visual acuity intact with low suspicion for [[GCA; TA ((Giant Cell; Temporal) Arteritis)]] or [[CRAO (Central RAO (Retinal Artery Occlusion))]]/CRVO. No vision changes or [[Conjunctival Injection]] with low suspicion for acute [[Angle Closure Glaucoma]]. No trauma to the eye and no sensation of [[Foreign Body]] with low suspicion for [[Cornea(l) Ulcer(ation)(s)]] or globe injury. No evidence of overt [[Hyphema]] or [[Hypopyon(s)]] on exam. No ocular pain or consensual [[Photophobia]] with low suspicion for scleritis or iritis. Plan to discuss case with ophthalmology for dilated exam and further assessment.
Patient is currently at baseline mental status and activity level per family. Patient does not have evidence of palpable [[Skull Fracture]]s or step offs. Patient does not have an occipital, parietal or temporal hematoma. Denies LOC > 5 seconds. No signs of basilar skull injury including [[Raccoon eyes]], [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], CSF rhinorrhea or hemotympanum. No nasal hematoma. Denies vomiting or headache. Denies severe mechanism of injury.
MDMPEP
After extensive discussion with patient regarding PEP versus observation/follow up and risks and benefits of both, mutual [[Decision Making]] to provide first dose of PEP and follow up promptly with outpatient testing and further treatment as needed at this time per most recent CDC HIV PEP guidelines for unknown relatively high risk exposures_. Discussed that single dose of PEP is not a substitute for follow up and further care/evaluation. Discussed need for concurrent testing of other STI including, but not limited to, G/C and RPR. Discussed safe sex practices_. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
Denies any ingestions and denies any other medical complaints. Does not endorse any [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Engages with conversation. Mood and affect are congruent. Thoughts are linear and organized, and has no AH or HI. Plan admit to psychiatry for further management of symptoms. Will consult psychiatry to evaluate Patient for potential hold for danger to self. Clinically no overt toxidrome, well appearing, low suspicion for ingestion given history and exam.
MDMRabies
_ with bat exposure who presents for [[IgA (Ig (Immunoglobulin) A)]]dministration. Patient without obvious wound but given duration of exposure, high risk nature and possible [[Incubation Period]] (of up to 1-3 months), mutual [[Decision Making]] with patient re: R/B/A to give dose of RiG. Per most recent CDC/ACIP guidelines re: PEP for human rabies, patient with 1st of 4-dose rabies vaccination regimen prior to arrival (0, 3, 7, 14; HDCV or PCECV). Discussed need for subsequent doses. Patient without altered immune competence. No obvious inoculation wound, as such, will infiltrate weight based RIG IM_. Patient currently largely asymptomatic with non-focal exam with no symptoms of cerebral dysfunction, anxiety, confusion, agitation, delirium, abnormal behavior, [[Hallucinations]], and [[Insomnia (Nighttime Wakefulness)]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
MDMRenalColic
Patient presents with flank pain consistent with previous [[Nephrolithiasis ((Kidney; Renal) Stone(s))]] pain. Patient otherwise well-appearing with low suspicion for sepsis, dissection or infected obstructed [[Renal Colic]]. US w/ mild [[Hydronephrosis; Ureterectasis (Hydro;Ureter(o));(nephrosis;ectasis))]] on affected side_. Low suspicion for atypical [[Appendicitis]], torsion, acute chole, or intraabdominal infection. Discussed conservative management, strict return precautions and follow up with urology. Will discharge with [[FLOMAX (Tamsulosin)]]_, [[NSAID (Non Steroidal Anti Inflammatory Drug)]], opiates for breakthrough, strainer, and antiemetics. Patient tolerating PO and [[Pain Control]]led prior to discharge. Strict return precautions for infected stone or PO intolerance discussed. Low suspicion for AKI, obstructive nephropathy given exam and history.
MDMSepticArthritis
Given exam and history, low suspicion for [[Septic Arthritis]] at this time given location of pain (not over knee joint but superior to area), subacute nature, and relative comfort to range of motion and axial loading. Nontoxic appearing and no overt systemic symptoms. Atraumatic with low suspicion for fracture or dislocation. No overt e/o [[NF (Necrotizing Fasciitis)]]. Given tenderness and area of erythema, will treat for cellulitis. Neurovascularly intact per routine as above with no overt e/o [[Compartment Syndrome]].
After extensive discussion with patient and wife regarding observation and treatment of possible cellulitis versus [[Arthrocentesis]] and risks (overlying cellulitis, lower [[Pre-Test]] probability of [[Septic Arthritis]], risk of inoculation of joint) and benefits of both, mutual [[Decision Making]] to trial antibiotics and not pursue further [[Arthrocentesis]] at this time. Patient tolerating discomfort, continue to be at baseline and well appearing. As above, does not have signs of systemic symptoms or neuro[[Vascular Compromise]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with increase in pain, inability to range or bear weight, or fevers.
MDMSyncopeFall
Patient presents after ground level fall, currently in c-spine precautions with likely LOC_. Unwitnessed fall, with unclear etiology, possible mechanical but cannot r/o syncope at this time. Patient without any [[Prodrome]] symptoms with low suspicion at this time for ACS, dissection or malignant [[Arrhythmia (Abnormal Rhythm)]]. Will check labs for electrolyte protuberances, will obtain CT brain and C-spine to evaluate for ICH as patient is [[Anti-Coagulation]]d_. Given history, low suspicion for ACS, but will obtain troponin and EKG for cardiac evaluation and reassess_. Currently at baseline mental status. No [[Respiratory Distress]] or hypoxia with low suspicion for massive PE at this time. Serial neurologic exams and monitor in interim.
MDMNeckSwelling
Patient otherwise healthy_, fully vaccinated_ with anterior neck swelling likely secondary to significant lymphadenopathy of limited duration with suspicion for likely viral etiology. BUS with visualization of LAD without frank abscess. Mild [[Tetanus (Tetany; Trismus; Lockjaw)]] on exam but no overt e/o PTA or RPA. No overt e/o deep space infection; nontoxic appearing and tolerating PO. Non-focal neuro exam with low suspicion for [[Lemierre Syndrome]]. Vaccinated with low suspicion for mumps. Low suspicion for malignancy or goiter formation at this time given duration but discussed prompt follow up to reassess. Trial antibiotics_ and [[Steroid]]_ with cautious return precautions discussed w/ full understanding. Airway fully patent.
Patient presents with epigastric_ [[Abdominal Pain]] most likely secondary to [[Dyspepsia (Indigestion)]] or non-acute abdominal etiology.
No peritoneal signs on abdominal exam.
Patient’s symptoms near resolved with GI cocktail.
Patient remains PO tolerant.
Serial abdominal exam without increase in [[Abdominal Pain]].
Given exam and history, low suspicion for acute abdominal process, such as [[Acute Cholecystitis]], [[Pancreatitis]], perforated viscus, atypical [[Appendicitis]] or torsion.
Extensive conversation about return precautions and need for follow-up.
Patient with rash likely allergic or [[Contact Dermatitis]] in nature given history, temporal nature and appearance. No mucous membrane involvement with low suspicion for SJS/TEN. No [[Wheez(-e -es; -ing)]] or difficulty breathing with low suspicion for systemic involvement. Unclear trigger but discussed close monitoring for progression. Will prescribe single dose of steroid given extent of rash and [[Hydrocortisone (Synthetic Cortisol; CORTAID)]] cream_. Cautious return precautions discussed w/ full understanding. No overt e/o superinfection. Prompt follow up with primary care physician discussed.
Patient with _ apical abscess over _lower right posterior molar presenting for [[Pain Control]]. Patient well appearing, no [[Tetanus (Tetany; Trismus; Lockjaw)]] or airway involvement. No systemic symptoms and no overt e/o deep space extension. Mutual [[Decision Making]] to perform inferior alveolar [[Nerve Block]] for temporary relief and continued control with short course of [[NSAID (Non Steroidal Anti Inflammatory Drug)]] and opiates as outpatient_. Apical abscess I+D extended and small amount of pus expressed with [[Decompression]] of lesion. Low cost dental resources given. Cautious return precautions discussed w/ full understanding.
MDMPEDS[[Appendicitis]]NoScan
Patient with [[Abdominal Pain]] and vomiting, now resolved_. No peritoneal signs with low suspicion for acute intraabdominal process including torsion, SBO, [[Intussusception]] or atypical [[Appendicitis]]. Serial abdominal exams throughout course without increase in pain or migration of pain. Tolerating PO in ED. US appendix inconclusive_. After extensive discussion with family regarding observation versus CT versus return for recheck in 8-12 hours if not resolved and risks and benefits of options, mutual [[Decision Making]] to return for recheck given relative improvement and well appearing child with alternative diagnoses (_) for fever and [[Malaise]] and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of peritoneal involvement. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting, increase in [[Abdominal Pain]], or altered behavior. Will discuss prompt follow up with PMD and strict return precautions discussed.
MDMBartholins
Patient with _ [[Bartholin Gland Cyst]] with concurrent abscess formation. No overt evidence of [[Fournier Gangrene]] or deep space involvement. No systemic symptoms. Small medial incision made with copious drainage of pus. Insertion of [[Word Catheter]] to maintain tract and follow up with OB/GYN discussed. [[Wound Care]] and return precautions discussed.
Patient with possible latrodectus envenomation to dominant hand_ several hours prior. Now with [[Constellation]] of symptoms, potentially consistent with mild envenomation including diffuse pain in extremity. Hand with possible area of early cellulitis but no frank abscess formation. Will treat with doxy given allergy profile after conversation with pharmacist. Area of inoculation without local [[Sweating]]. No overt evidence of necrosis or abscess. No cardiothoracic symptoms, no peritoneal signs. At this time, will trial [[Pain Control]] and muscle relaxants. Will continue to monitor and will hold antivenom at this time. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] up to date.
with no previous medical history presents brought in by parents for superficial scattered burns primarily to torso_ with minimal BSA involved. Burns superficial, consistent with history and given interaction observed between parents, low suspicion at this time for NAT. Parents and patient appropriate. Patient undressed fully without any suspicious lesions. Discussed [[Wound Care]], [[Pain Control]] and follow up with PMD. Return precautions for superinfection. Patient at baseline currently without significant burns over scalp, face, groin or distal extremities. Cautious return precautions discussed w/ full understanding.
with atypical [[Chest Discomfort]] and now resolved palpitations in the setting of Adderall_ use. No overt risk factors for early cardiac disease; no family history of early cardiac death. Patient well appearing, nontoxic. Low Wells score with low s/f PE; no overt hypoxia. Given history and exam, low suspicion for ACS, dissection, or [[PTX (Pneumothorax)]]. Discussed cessation of Adderall_ and follow up with PMD for further evaluation as needed. Cautious return precautions discussed w/ full understanding.
with history of tobacco abuse, otherwise healthy, p/w atypical chest pain, subacute worsening of [[Chronic Pain]]. No overt risk factors for ACS and serial EKGs and troponins without overt e/o [[NSTEMI (Non ST (Segment) Elevation [[MI (Myocardial Infarction)]])]]. Pain reproducible on exam with likely [[MSK (Musculoskeletal)]] component. Low Wells score with low risk for PE and no significant hypoxia_. Given chronicity, low s/f dissection. [[Pain Control]]led, well appearing. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
p/w atypical chest pain, subacute onset of atypical chest pain. No overt risk factors for ACS aside from HLD_ and EKG w/o overt e/o [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]]. Pain reproducible on exam with likely [[MSK (Musculoskeletal)]] component. Low Wells score and PERC negative with low risk for PE and no significant hypoxia. Given duration, low s/f dissection. [[Pain Control]]led, well appearing. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
Patient presents with chest pain without signs of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] on ECG. Patient given aspirin and is currently chest pain free. Low Wells score with low risk for PE and no significant hypoxia_. Given exam and history, low suspicion for dissection. No ectopy noted on monitor and patient well appearing. Had conversation with pt at length regarding risks vs benefits of admission to obs for chest pain. Mutual [[Decision Making]] for patient to be admitted to obs, and agrees to workup. Low suspicion for overt ACS but given age and persistence of symptoms, plan to admit to obs for [[Serial Troponin]], serial EKGs, and risk stratification as inpatient.
with worsening [[SOB (Shortness of Breath)]] over the past few weeks with [[Constellation]] of symptoms concerning for possible [[CHF (Congestive v[[HF (Heart Failure)]])]] exacerbation. Patient not overtly hypoxic with minimal [[Respiratory Distress]]. No overt evidence of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] on EKG. Will trial [[Nitroglycerin(e)]] for afterload reduction, [[Diuresis]] with strict I/O presuming no evidence of AKI or cardiorenal syndrome_. Trend troponin although low suspicion for [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] given history and exam_. Low suspicion for acute PE given exam and history. Given decline in functional status, consider admission for [[Diuresis]] and further cardiac evaluation_.
MDM[[Clavicular]]Fracture
Patient with L_ minimally displaced [[Clavicular Fracture]] after falling onto L side. Distally neurovascularly intact in extremities. No overt evidence of significant head trauma. Mentating well with non-focal neurologic exam. Placed in sling and [[Adhesive Capsulitis (Frozen Shoulder Syndrome)]] precautions discussed. Follow up with pediatric orthopedics. Return precautions.
presenting s/p minor head trauma with headache, lightheadedness, and nausea_. Given mechanism and nonfocal neurologic exam, low suspicion at this time for ICH or significant C-spine injury. Concussion care and precautions discussed. After extensive discussion with patient and family_ regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Patient with nonfocal neurologic exam and with low suspicion for overt ICH. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.
presenting with 1 day of left [[Eye Pain]]_ after irritation yesterday. Patient is a contact lens-wearer. Visual acuity otherwise preserved. Given exam and history, no overt evidence of scleritis, purulent conversion, or [[Cornea(l) Ulcer(ation)(s)]]. Patient does however have small [[Corneal Abrasion]], which will be treated with antibiotic eyedrops_. Patient to avoid wearing contacts in interim and prompt follow up with ophthalmology discussed.
Patient without overt maloccusion and given mechanism and history, low suspicion at this time for significant mandibular or maxillary fracture and will defer imaging at this time. Prompt follow up with plastics arranged and discussed. In regards to fractured dentition, likely Ellis II_, patient with access to [[Dentist]] in 24 hours and after R/B/A discussed, patient deferred antibiotics and cementing of tooth which is reasonable given degree of fracture and prompt follow up. Strict return precautions discussed.
with isolated episode of [[Binocular Diplopia]] now resolved with nonfocal neuro exam with low suspicion for TIA.
Patient with minimal neurovascular/CVA risk factors and with prompt follow up with neurology already arranged.
Low suspicion given exam and history for CNS or facial infection including meningitis or [[CST (Cavernous Sinus Thrombosis)]] (no facial tenderness, ptosis and no limitation of [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]], IV, V, VI) , aneursym (no e/o [[CN3 (Cranial Nerve III) Palsy]], headache, no personal or family history).
No e/o [[Horner Syndrome]] or inflammatory process (i.e. GBS/MF, myasthenia, or [[GCA; TA ((Giant Cell; Temporal) Arteritis)]]).
Exam and history with no overt e/o monocular diplopia with low suspicion for acute media or refractive pathology, [[Optic Neuritis]], or uveitis.
with elbow pain after fall. X-ray does not reveal any overt fractures. Discussed discharge instructions with patient and return precautions. Given sling for comfort and [[Adhesive Capsulitis (Frozen Shoulder Syndrome)]] precautions discussed. No overt e/o [[Compartment Syndrome]] or [[Supracondylar Fracture]]. Distally NVI per routine. Patient is well-appearing, in no apparent distress, and vital signs stable for discharge home. Return precautions for occult fracture and return for repeat imaging if needed discussed.
Patient with ground level fall _ without frank head trauma and non-focal neurologic exam. Patient with multiple abrasions but no lacerations requiring repair_. Affected areas inspected, irrigated and dressings applied. [[Wound Care]] discussed. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] up to date. Patient initially with mild headache_, single episode of emesis_ without frank abdominal injury and [[Shoulder Pain]], now resolved_. Given nonfocal exam and currently well appearing, query possible mild concussive symptoms_. As above, given mechanism and nonfocal neurologic exam, low suspicion at this time for ICH or significant C-spine injury. Concussion care and precautions discussed. After extensive discussion with patient and companion regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Friend agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.
otherwise healthy, full term, brought in by parents for 1 day_ of increased fussiness. Afebrile, full term, currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing [[(Iso;Eu)volemia]] with appropriate linear [[Weight Gain]] since birth. No meningismus, otherwise at baseline activity level with low suspicion for [[CNS (Central Nervous System) Infection]]. Patient wearing mittens_, no excessive tearing or redness, and without long nails with low suspicion for [[Corneal Abrasion]]. No overt evidence of NAT or hair tourniquets. No malignant rashes noted and improving [[Diaper Rash]] per parents on exam. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of [[CNS (Central Nervous System) Infection]] including but not limited to changes in mental status or vomiting, or fever. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.
presenting with 3 days_ of vomiting and [[Diarrhea]]. Currently [[(Iso;Eu)volemia]] without any abdominal tenderness or peritoneal signs. Nontoxic appearing; query possible [[Gastroenteritis]]. Patient also with URI symptoms and a cough over past several days – suspect viral etiology and will low suspicion for pneumonia at this time_. Nausea control, rehydrate, serial abdominal exam, reassess. At this time, given initial history and exam, low suspicion for torsion, PID, atypical [[Appendicitis]] or [[Cholecystitis]].
not on [[Anti-Coagulation]]_ with resultant laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] updated. NVI distally. Relatively clean wound, irrigated copiously and repaired in simple fashion with dermabond. No antibiotics indicated at this time. Given mechanism and nonfocal neurologic exam, low suspicion for ICH or significant c-spine injury. Discussed strict return precautions and [[Wound Care]].
otherwise healthy with moderate risk HIV exposure (unprotected vaginal sex with HIV+ patient albeit with unclear last CD4 + VL)_. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]]/C, RPR, G/C and HIV and relative rates given source patient and mechanism. Patient declining vaginal exam to evaluate for tears at this time after risks discussed with full understanding and capacity. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given risk of transmission, mutual [[Decision Making]] to use PEP at this time. Discussed prompt follow up with clinic for bloodwork and serial serologies. Discussed at length regarding consensual nature of sex and patient does not feel that encounter was not consensual. Discussed that if patient changes mind, given STI treatment center resources. Patient contracts to safety and feels safe at home.
Given history, per CDC (2013) and NYSDOH (2014), patient not pregnant and will treat with Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Either Raltegravir 400 mg PO twice daily. Discussed post exposure testing at baseline6 weeks post-exposure, 12 weeks post-exposure. 6 months post-exposure at clinic. Will provide 5 days of PEP_ but discussed prompt need for follow up and full course being at least 4 weeks. Cautious return precautions discussed w/ full understanding.
subacute worsening of chronic [[Right Knee Pain]]. Atraumatic. Neurovascularly intact distally. Given [[Focal Tenderness]], query possible MCL strain vs [[Bursitis]]. No systemic symptoms and nontoxic; given exam and history, low suspicion for [[Septic Arthritis]], pyomyositis or [[NF (Necrotizing Fasciitis)]]. No e/o [[Compartment Syndrome]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].
MDMKneePainTrauma
with R_ knee pain and mild swelling after injury. Neurovascularly intact distally. Given [[Focal Tenderness]], query possible ligamentous injury however no gross instability. No tibial plateau tenderness. XR without frank fracture. Low suspicion for [[Vascular Injury]] with dislocation-relocation. No ankle or [[Hip Pain]]. No [[Back Pain (Dolor)]] with low supicion for significant axial load. No systemic symptoms and nontoxic; given exam and history, low suspicion for [[Septic Arthritis]], pyomyositis or [[NF (Necrotizing Fasciitis)]]. No e/o [[Compartment Syndrome]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]. [[Pain Control]]. Follow up with PMD and ortho as needed. Cautious return precautions discussed w/ full understanding.
with chin injury and superficial arm abrasions s/p fall from scooter_ prior to arrival. Pt with resultant chin laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] UTD. No maloccusion with low suspicion for mandibular fracture. No LOC and low suspicion for ICH. Relatively clean wound, irrigated copiously and repaired in simple fashion with sutures. No antibiotics indicated at this time. Discussed strict return precautions, follow up for suture removal and [[Wound Care]]. Extremity exam with full range of motion, no [[Bony Tenderness]] and distally neurovascularly intact.
with resultant laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] updated. XR w/o overt e/o fracture. NVI distally. Relatively clean wound, irrigated copiously and repaired in simple fashion with staples_. No antibiotics indicated at this time. NVI per routine post repair. No overt e/o [[Compartment Syndrome]]. Discussed strict return precautions, follow up for staple removal and [[Wound Care]].
with history of chronic intermittent [[Migraine (Headache)]], recently started on triptan_, now presenting with similar [[Constellation]] of symptoms without overt evidence and low suspicion for [[ICH (Intracranial Hemorrhage)]], [[SAH (Subarachnoid Hemorrhage)]], or CNS affection. Patient with non-focal neuro exam. Patient not immunocompromised and no family history of bleeding dyscrasias or aneursymal rupture. Headache slow onset and similar to prior exacerbations. Will attempt [[Pain Control]], serial neuro exams, and reassess.
otherwise healthy involved in restrained MVA with airbag deployment. Patient with pain predominantly to L paraspinal and L [[Clavicular]] area_. [[Hemodynamic]]ally appropriate with nonfocal neurologic exam. Given exam and history, low suspicion for traumatic dissection or ICH. CT c-spine without overt fracture or dislocation with low suspicion for ligamentous injury on re-examination. Serial abdominal exam without tenderness and FAST initially unremarkable. Observed for several hours in ED with clinical improvement. Stable gait and tolerating PO. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
with no pertinent history presents with now resolving R_ paraspinal neck pain. No acute findings on exam; in particular, no midline spinal tenderness to palpation. Non-focal neuro exam with sensation and strength intact and equal bilaterally. Low suspicion for cervical ligamentous or [[Vascular Injury]]. Intact grips and UE exam with low suspicion for central cord. Discussed [[Pain Control]], observation of symptoms. Cautious return precautions discussed w/ full understanding.
Patient denies severe mechanism of injury.
Patient does not have overt evidence of abdominal wall trauma or [[Seatbelt Sign]].
Patient is currently alert and at baseline mental status and activity level per family.
Patient denies any abdominal tenderness and does not have evidence of thoracic wall trauma.
Breath sounds remain equal bilaterally.
Denies nausea or vomiting.
with vaccinations up to date_, full term, otherwise healthy boy presenting with fever and [[Constellation]] of upper respiratory symptoms. Currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing [[(Iso;Eu)volemia]]. Mild fever and well appearing after [[Ibuprofen; ((ADVIL), (MOTRIN))]] administration. No meningismus, otherwise at baseline activity level with low suspicion for [[CNS (Central Nervous System) Infection]]. Query likely viral etiology. Discussed low risk but possible UTI and offered catherterized urine sampling, but mutual [[Decision Making]] at this time to defer after discussion with parents_. Discussed alternating tylenol and [[Ibuprofen; ((ADVIL), (MOTRIN))]] as directed over the counter for antipyresis. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of [[CNS (Central Nervous System) Infection]] including but not limited to changes in mental status or vomiting, or fever for more than 5 days. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.
[[Immunization]]s UTD_, otherwise healthy, not immunocompromised, presenting with fever and [[Malaise]]. [[Constellation]] of symptoms and history concerning for possible UTI_. Patient is extremely well appearing, mentating well, at baseline per parents, lucid and without meningismus. Nonfocal neuro exam with low suspicion for [[CNS (Central Nervous System) Infection]]. No [[Respiratory Distress]] with low suspicion for pneumonia. No [[Abdominal Pain]] and benign abdominal exam with low suspicion for atypical [[Appendicitis]]. No overt findings for vulvovaginitis_. UA with some WBC and + LE_. Given symptoms, will treat with [[Cephalexin (KEFLEX)]]_ for possible upper tract infection. Tolerating PO including juice and crackers in ED. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. [[Appendicitis]] return precautions discussed.
with positional chest pain for the past 2 days_. Recent mild cough, [[Sore Throat (Pharyngitis)]]_. EKG obtained consistent with [[Pericarditis]]. BUS w/o overt tamponade or significant effusion. Query possible [[Recent [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]]]] as trigger. No overt e/o AKI or CKD, malignancy, HIV, TB. No overt high risk factors for complicated [[Pericarditis]] including fever, no e/o large [[Pericardial Effusion]] or tamponade, no immunosuppression, [[Anti-Coagulation]], or trauma. Low suspicion given history and exam for concurrent [[Myocarditis]], ACS or PE. Discussed activity restriction until symptom resolution. Discussed treatment with [[NSAID (Non Steroidal Anti Inflammatory Drug)]] ([[Ibuprofen; ((ADVIL), (MOTRIN))]] TID per ESC guidelines) with low risk for GIB (no history of PUD, age < 65, and no concurrent [[Anti-Coagulation]]) and cotreatment with [[Colchicine (MITIGARE, COLCRYS)]] given lack of risk factors for toxicity (low suspicion for CKD given age) and potential benefits (significant reduction in the risk of recurrence – ICAP trial NEJM 2013)_. Discussed need for close follow up with ASHE and cardiology referral as well as strict return precautions for worsening chest pain, signs of [[CHF (Congestive v[[HF (Heart Failure)]])]]/fluid overload/tamponade, or infection.
presenting with increased anxiety with clear trigger now resolved. Given exam and history, low suspicion for acute cardiopulmonary process including dissection, ACS, or PE. Denies any acute ingestions and denies any other medical complaints at this time. Does not endorse any [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Engages with conversation. Mood and affect are congruent. Thoughts are linear and organized, and has no AH or HI. No acute need for psychiatric consultation and patient without SI or HI. Clinically no overt toxidrome, well appearing, low suspicion for ingestion given history and exam. Contracted for safety as well as demonstration of significant insight for finding homeless shelter and follow up. Cautious return precautions discussed w/ full understanding.
fully immunized, otherwise healthy, p/w isolated rash likely due to viral exantham_ given history, temporal nature and appearance. No mucous membrane involvement with low suspicion for SJS/TEN. No [[Wheez(-e -es; -ing)]] or difficulty breathing with low suspicion for systemic involvement. Low suspicion for scabies given history and exam. Discussed close monitoring for progression. Cautious return precautions discussed w/ full understanding. No overt e/o superinfection. Prompt follow up with primary care physician discussed.
MDMScabies
subacute rash over months_. Given distribution, characteristics and associated symptoms, likely secondary to scabies vs bedbugs. No overt mucosal involvement w/ low s/f TEN/SJS/EM. No e/o superinfection. Discussed hygiene/de[[Contamination]] measures, continue ivermectin and [[Permethrin]]_; symptomatic t/w [[Diphenhydramine (BENADRYL®)]] and steroid burst. F/u w/ dermatology as discussed. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
s/p [[Renal Transplant]]_ and s/p OHT_ who presents with fever for past several days and intermittent [[Productive Cough]]_. Despite patient being well appearing, will perform septic workup with concern for possible CAP. Will obtain CXR, labs, blood cultures, urine cultures, UA. Will also get troponin (to evaluate for [[Myocarditis]]), [[BNP; BNF (Brain Natriuretic (Factor; Peptide))]] (to trend for possible rejection). No overt evidence of fluid overload at this time. No overt hospital acquired risk factors but given immunosuppression and concern for pulmonary cause, will empirically treat with vanc/[[Cefepime (MAXIPIME, VOCO)]]/[[Azithromycin (ZITHROMAX, Z-PACK)]]_ and will defer to medicine team to narrow. Although grafts working well on prior visit, as patient not overtly septic, will gently hydrate with NS given [[Hemodynamic(ally) (Stability, Stable)]] and propensity for possible graft dysfunction/fluid overload_.
who presents with fever and ¾_ [[Systemic Inflammatory Response Syndrome (SIRS) Criteria]]. Resuscitation via EGDT with 30 cc/kg NS bolus with stabilization in vitals. Empiric [[Antibiotic Therapy]], albeit with modified regimen given suspected intraabdominal source_ and allergy profile_. CXR, cultures, and UA. Consider [[NE (NoreEpi, Norepinephrine, Noradrenaline LEVOPHED)]] if patient not fluid responsive. Monitor [[Hemodynamic]] status. Admit to medicine for further care.
with history of SSD Hb SS_, functionally asplenic_, [[Immunization]]s for encapsulated organisms reportedly up to date, complicated prior by_ [[Avascular Necrosis]] of humerus and femur, and [[Acute Chest Syndrome]]_, last transfusion several months prior_, baseline hgb _ now presenting with [[Constellation]] of symptoms similar to prior acute vasooclusive pain crises without overt trigger. Patient is afebrile, not hypoxic and without [[Dyspnea]] with low suspicion at this time for [[Acute Chest Syndrome]]. Will trend [[Hb (Hemoglobin)]] and [[Reticulocyte Count]] to evaluate for possible hemolytic vs aplastic crisis, although low suspicion at this time. No overt worsening of [[Avascular Necrosis]] or [[Osteomyelitis]] on exam. Nonfocal neuro exam with low suspicion at this time for end [[Organ Dysfunction]] from VOC including CVA, ACS, AKI or hepatobiliary complications. Will continue to monitor, [[Pain Control]], gentle hydration, and follow up labs.
MDMStye
with stye vs chalazion to right upper eyelid. Patient well appearing without overt evidence of septal or pre-septal cellulitis. No overt evidence of [[CST (Cavernous Sinus Thrombosis)]]. Will discharge with recommended warm compresses at home and optho follow-up this week. Low suspicion for [[Foreign Body]] or [[Corneal Abrasion]] given history and exam.
who presents with syncope prior to arrival. Witnessed syncope, likely vasovagal in etiology given history and exam. Patient currently at baseline mental status. No chest pain with low s/f dissection or ACS. No hypoxia or tachypnea with no risk factors for PE. No overt e/o malignant [[Arrhythmia (Abnormal Rhythm)]] on serial EKG. Patient not pregnant_. PO challenge. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed for further workup as needed.
with otherwise healthy, fully vaccinated with [[Sore Throat (Pharyngitis)]] likely secondary to viral URI vs [[[[Strep(tococc(us;I;al))]] Pharyngitis]]. No [[Tetanus (Tetany; Trismus; Lockjaw)]] on exam and no overt e/o PTA or RPA. No overt e/o deep space infection; nontoxic appearing and tolerating PO. Centor _. Non-focal neuro exam with low suspicion for [[Lemierre Syndrome]]. Trial antibiotics and [[Steroid]] with cautious return precautions discussed w/ full understanding. Tolerating PO and otherwise well appearing.
MDMURI
otherwise healthy presenting with [[Constellation]] of symptoms likely representing uncomplicated viral upper respiratory symptoms as characterized by mild [[Sore Throat (Pharyngitis)]] without overt evidence of RPA/PTA, deep space infection/[[Ludwig Angina (Dental Sepsis)]]’s, or bacterial superinfection_. Low suspicion for [[CNS (Central Nervous System) Infection]] bacterial sinuitis, or pneumonia given exam and history. Will attempt to alleviate symptoms conservatively; no overt indications at this time for antibiotics. No [[Respiratory Distress]], otherwise relatively well appearing and nontoxic. No peritoneal signs with low suspicion for acute intraabdominal process. Will discuss prompt follow up with PMD and strict return precautions discussed.
MDMUTIMale
with with no significant medical history who presents with UTI without overt e/o infected stone or prostatitis. BUS w/o overt e/o [[Hydronephrosis; Ureterectasis (Hydro;Ureter(o));(nephrosis;ectasis))]]_. Rectal w/o e/o abscess formation, deep space infection or prostatitis_. No e/o [[Epididymo-Orchitis]] on exam. Abdomen benign with minimal suprapubic TTP. No CVAT. Febrile, but otherwise well appearing and reliable. Given dose of [[Ceftriaxone (ROCEPHIN)]] and d/c w/ Cipro_. Cautious return precautions discussed w/ full understanding. [[Appendicitis]] and [[Abdominal Pain]] precautions given for return. Prompt follow up with primary care physician discussed.
[[PE (Physical Exam(ination))]]
PEAnkle
NVI per routine with appropriate cap refill, extension and flexion of digits, sensation intact to FT throughout
No pain over 1st and 5th MTP
No medial or lateral malleolar tenderness
No proximal tib/fib pain
(+) small _ cm abscess over interdental papilla of right lower premolar_ between teeth 29 and 30_ with mild gingival thickening, otherwise gingival tissues pink and stipple and firm. No discharge, no blood visualized.
Otherwise, patient with no exudate to bilateral tonsillar beds and no erythema to upper palate or tonsillar beds. No uvular deviation. Full range of motion of neck. No evidence of overt RPA or PTA on exam. Non-elevated [[Tongue]] with soft lower palate. No [[Carotid Artery Bruit]] heard in neck. No petechiae around face or neck. No LAD appreciated. Supple.
Comfortably resting, lying in bed, NAD, non[[Sweating]], lucid, fully conversant, no [[Respiratory Distress]], alert and oriented.
Testicular exam with normal lie and CMR bilaterally, no significant erythema, tenderness or swelling appreciated. No appreciable [[Inguinal Hernia]] bilaterally. No rashes or lesions. No penile discharge. No blood at meatus.
PEHand
2+ RP symmetric bilaterally. CR < 2 seconds bilaterally. Neurovascularly intact to radian, median, ulnar per routine to both fine touch and motor in distal hands.
Right hand:
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.
Left hand:
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.
PEHeadTrauma
No [[Septal hematoma]], TM x2 clear w/o e/o hemotypanum or CSF rhinorrhea, no [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], [[Raccoon eyes]] or csf rhinorrhea, no e/o entrapment, no diplopia on EOM, PERRL, EOMI. No facial tenderness over zygoma, mandible or maxilla. No malocclusion or [[Tetanus (Tetany; Trismus; Lockjaw)]]. TMJ grossly intact. Midface stable. Nose midline without significant deviation. No ML C-spine TTP.
PEKnee
Full range of motion of right ankle, right knee without pain, (-) right [[Patellar]] tenderness. Negative mcburney’s, negative Lachman’s, [[Posterior Drawer Test]]. 5/5 strength of ankle, knee and hip with stable gait. No effusion appreciated.
PELowerExtremity
No [[Lower Extremity Edema]], asymmetry, erythema or pain. 2+ DP.
Mental status: oriented, alert, lucid, cooperative, appropriate.
Cranial nerves: [[CN 2 (Cranial Nerve (Two; II); Optic)]]-12 intact
Motor: 5+ UE and LE, flexors and extensors symmetric.
Sensation: Grossly intact to fine touch UE and LE symmetrically.
Cerebellar: normal FTN bilaterally. No tremor noted.
Gait: normal gait
Tone: normal bulk and tone in upper and lower extremities. No atrophy noted.
Visual Acuity:
OD: 20/20
OS: 20/20
OU: 20/20
No pinhole, no lens
Pupils:
OD: 4à2
OS: 4à2
APD: none
[[IOP (Intraocular Pressure; 10–20 mmHg)]] –
Tp OD: 15
Tp OS: 15
Extraocular motility: FULL OU
Confrontational fields: intact in all fields OU.
[[Slit Lamp]] exam:
Lids and lashes: No edema and no periorbital erythema
Conjunctiva and Sclera: no injection OU
Cornea: no stromal edema, no ED OU
[[Anterior Chamber]]: no cell, no flare OU
Iris: round and reactive OU
Lens: IOL OU
PEPEDSGEN
At baseline, well appearing, smiling, interactive, playing with mother. Nontoxic appearing. No tripoding, no drooling. Verbalization at baseline.
12.PEPULM
No overt [[Respiratory Distress]]. No tripoding or [[Accessory Muscle Use]]. No cyanosis. No clubbing. No stridor or audible [[Wheez(-e -es; -ing)]]. No visualizable [[Foreign Body]] or mass in [[Upper Airway]].
Full range of motion of left ankle_, (+) _ [[Patellar]] tenderness. 5/5 strength of left ankle, knee and hip but limited by pain. Possible small knee effusion on ballotment_. Mild erythema over anterior superior knee _. No pain [[Out of proportion]]; area traced out and observed throughout ED stay without extension. No pain on axial loading. Passive and active ROM to 120 degrees without significant discomfort. + TTP over area of erythema w/o fluctuance. 2+ DP.
No tenderness to shoulder, no limited flexion and abduction of shoulder secondary to pain, rotator cuff tests are negative. Able to touch opposite shoulder with hand. No deformities. Radian, medial, and ulnar nerves intact to motor and sensation. Good distal pulses and good cap refill.
There is no bruising and no laceration of the skin. The clavicle is not elevated, and the skin is not tented. No sulcus sign when palpating the [[Humeral Head]] and scapula. No scapular tenderness. He has intact [[Axillary Nerve]] sensation. He has no pain or limitation to ROM of elbow, or wrist. He has intact motor distal but limited ROM of the shoulder due to pain.
PEThroat
Patient with no exudate to bilateral tonsillar beds and no erythema to upper palate or tonsillar beds. No uvula deviation. Full range of motion of neck. No evidence of overt RPA or PTA on exam. Non-elevated [[Tongue]] with soft lower palate. No [[Tetanus (Tetany; Trismus; Lockjaw)]]. No [[Carotid Artery Bruit]] heard in neck. No petechiae around face or neck. No LAD appreciated. FROM, supple.
PEAllergicDermatitis
(+) blanching [[Nontender]] mildly pruritic maculopapular centrally confluent rash with satellite lesions over _. Negative nikolsky’s. No perineal, scrotal or mucosal involvement_. No discharge or crusting.
No TTP over C/T/L/S midline
Diffuse nonconfluent pinpoint erythematous blanching [[Papular Rash]] predominately over thorax, extremities_. Pruritic, [[Nontender]], non discharge, some with overlying excoriations without evidence of cellulitis or superinfection. No tenderness to palpation. Negative nikolsky’s. No predominance over flexor creases. No involvement of nails or web spaces of hands.
Pelvic Exam: Closed Os, no purulent mucopurulent cervical exudate. no cervical friability, no cervical erythema, edema. No Adnexal Tenderness, no CMT. No [[Vaginal Vault]] Discharge or lacerations.
History and Physical
HPIBackPain
Patient has no history of malignancy, active or distant history. Patient is not less than 16 or greater than 50. Patient has no unexplained weight loss. No recent fevers, rigors, [[Malaise]], or recent infection. No history of [[IVDU; IVDA (IV (Intravenous) Drug Abuse)]] or skin-popping. Patient does not have any [[Saddle Anesthesia]]/[[Perianal]] sensory loss or complaining of [[↓ Rectal Tone]]. Patient does not have [[Urinary Retention]] or inability to control urine from overflow. Patient has no tenderness overlying spinous process. Patient has normal gait and able to walk on heels/ toes. Patient has no focal weakness on examination. Patient does not have hyperreflexia on examination.
HPIChestPain
Patient has a history significant for _.
[[Chest Discomfort]] is described as a pressure/sharp/dull sensation without/with radiation to neck/arm/back. Patient has had this chest pain before. Chest pain is nonexertional. Chest pain started at _ and has been intermittent/constant/progressive/nonprogressive. Patient last chest pain was at _.
Chest pain is non-pleuritic and not positional_. Chest pain is not associated with food.
Patient endorses the following symptoms: _
Patient denies any associated symptoms, including [[Near Syncope]], syncope, palpitations, [[SOB (Shortness of Breath)]], nausea, vomiting, [[Sweating]]._
Denies [[Orthopnea ([[SOB (Shortness of Breath)]] (dyspnea) That Occurs When Lying Flat)]], PND, or LEE.
Denies upper respiratory symptoms or [[Productive Cough]].
Patient denies any [[Lower Extremity Edema]], pain, asymmetry, or swelling.
Denies prior [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]/PE or history of malignancy or known [[(Hypercoagulable; Prothrombotic) (State; Disorder; Condition) (Thrombophilia)]].
Patient has had no decline in their exercise tolerance.
Patient denies any tearing chest pain.
Patient denies any early family history of cardiac death or MI.
Patient has been compliant with home medications
HPI5Ds
No [[Dysphagia]], [[Dysarthria]], diplopia. No difficulty with gait or coordination.
HPIAMS
_ presents with [[AMS (Altered Mental Status)]].
Patient’s history is notable for: _.
Patient was brought in by _. Patient was found at _.
Denies ingestion. _
Patient without history of similar in past._
Glucose in field was _.
Denies seizure history. No seizure activity witnessed. Denies incontinence or [[Tongue]] biting._
Denies falls or recent trauma._
HPIAbdominalPain
Patient presents with [[Abdominal Pain]].
Patient’s history is notable for: _.
Patient first noted the [[Abdominal Pain]] _. Pain is at diffuse/RUQ/LUQ/RLQ/[[LLQ (Left Lower Quadrant)]]/epigastric _. Discomfort is described as a pressure/sharp/dull_ sensation without/with _ radiation to groin/back. Patient has had this [[Abdominal Pain]] before_. Pain is nonexertional and not positional_.
Pain is not associated with food_. Pain is alleviated by _ and worsened by _.
Patient denies past abdominal surgeries. Last [[Bowel Movement]] was _. Endorses flatus._
Denies nausea or vomiting. Able to tolerate PO without difficulty._
Denies [[Diarrhea]], [[BRBPR (Hematochezia; Bright Red Blood Per Rectum)]], or [[Melena (Dark Tarry Stool)]]._
Denies [[Dysuria]] or [[Hematuria]]. Denies flank pain. _
Denies recent travel._
Denies recent antibiotics or hospitalizations._
vaccinations up to date_, full term, otherwise healthy boy_ who presents with upper respiratory symptoms including a non[[Productive Cough]], congestion and [[Coryza]] for 2-3_ days. Patient also with fever for 2 days_. Endorse sick contact_ in father with similar symptoms. Stable UOP. No nausea or vomiting. Normal PO intake. No rashes. At baseline mental status and activity level without [[Lethargy]]. No recent travel. No overt [[Abdominal Pain]], headache, ear pain, or [[SOB (Shortness of Breath)]]. No increase in respiratory effort.
Patient is asymptomatic currently and at baseline_. Patient was seen in clinic today by primary OB and patient had two mildly [[↑↑↑ [[BP (Blood P (Pressure))]] ↑↑↑]] readings_. Patient denies known personal and family history of [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]]_. Denies headache or vision changes, including [[Photophobia]], [[Blurred Vision]], and [[Scotoma(ta); [[Visual Field(s)]] (Defect; Deficit)]]. Denies [[Abdominal Pain]], nausea, vomiting, focal weakness or parasthesias. Endorses persistent, although stable, intermittent [[Lower Extremity Edema]] without further asymmetry or pain. Denies chest pain or [[SOB (Shortness of Breath)]]. Denies PND or DOE. Denies oozing with brushing teeth or new easy bruising. Denies [[Vaginal Bleeding]], loss of fluid, [[Contractions]]. Endorses stable and active movement of fetus.
_who presents with SI_.
Patient’s history is notable for: _. Patient was brought in voluntarily/by family/by police_. A temporary hold was/was not placed prior to arrival. _
Patient was in normal state of health until approximately _ days ago. At this time, patient noted _. Patient came in today due to _.
Patient endorses SI with plan to _.
Denies previous suicide attempt. Patient has been compliant with his medications._
Patient denies any ingestions including tylenol or aspirin._
Denies [[Illicit (Substance; Drug) (Use)]] including [[IVDU; IVDA (IV (Intravenous) Drug Abuse)]], [[Amphetamines]], [[Marijuana (Cannabis)]], or alcohol. _
Patient is seen by Dr. _.
Denies previous hospitalizations._
Denies [[Hallucinations]], auditory or visual._
Denies HI/HA._
Patient is able to perform daily functions and contracts to safety._
HPIPEDSRash
fully vaccinated, otherwise healthy M_ who presents with rash for past day_. Rash started centripetally_ and is scattered papular mildly pruritic over chest and face_ with no oral involvement. Patient with mild URI symptoms several days prior and fever, now resolved. Patient otherwise at baseline with baseline mental status, activity level, UOP and PO intake intact. Denies sick contacts. Denies other family members with rash. Denies discharge, fevers, recent travel/hospitalizations/antibiotics.
HPISOB
presents with [[SOB (Shortness of Breath)]]. Patient’s history is significant for _.
Patient first noticed increased [[SOB (Shortness of Breath)]] _. [[SOB (Shortness of Breath)]] has been progressive_. Denies alleviating or exacerbating factors_. Denies similar episodes in past. Denies changes in position. Denies pleurisy.
Denies chest pain, [[Abdominal Pain]], nausea or vomiting. Denies fevers._
Denies home oxygen requirement or increase in oxygen requirement._
Denies recent travel. Denies sick contacts_.
Denies upper respiratory symptoms, including [[Productive Cough]], [[Hematemesis]], [[Sore Throat (Pharyngitis)]] or runny nose._
Denies [[Lower Extremity Edema]], swelling, asymmetry or pain._
Denies history of [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]/PE. Denies known malignancy or [[(Hypercoagulable; Prothrombotic) (State; Disorder; Condition) (Thrombophilia)]].
Denies smoking or OCP use.
Patient has been compliant with home medications.
otherwise healthy p/w four_ days of [[Productive Cough]] without [[Hemoptysis]], mild chills now resolved, no overt fever, also associated with concurrent [[Coryza]] and congestion_. Denies chest pain or [[SOB (Shortness of Breath)]]. Denies LE edema, asymmetry or pain. Denies AP, n/v. Denies headache, fevers or chills. Denies [[Orthopnea (Shortness of Breath (dyspnea) That Occurs When Lying Flat)]] or PND. + sick contact also with similar [[Constellation]] of symptoms. No travel.
Progress Notes
PROGAlcohol
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient with increased lucidity, tolerating PO, interactive with staff. [[Hemodynamic(ally) (Stability, Stable)]].
Trialed gait after several hours of observation in the ED with improvement in mental status to baseline and with stable gait. Cautious return precautions discussed w/ full understanding.
PROGAMA
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.
PROGAnkle
X-ray does not reveal any fractures, likely ankle sprain. Discussed discharge instructions with parents and return precautions. Parents expressed verbal understanding and agreement with care plan. All questions answered. Given crutches and an ankle brace. Patient is well-appearing, in no apparent distress, and vital signs stable for discharge home.
PROG[[Asthma]]
Patient reassessed and respiratory status has stabilized while in the department and appears appropriate for outpatient work up. Exam and work up not consistent w/ impending [[Respiratory Failure]] or cardiovascular collapse. Afebrile with low suspicion for acute pneumonia. Patient not hypoxic, fully ambulatory without [[Respiratory Distress]]. Medications refilled and strict return precautions discussed.
PROGECG
EKG reviewed, no overt evidence of contiguous [[ST (Segment) Elevation]]s, low suspicion for acute MI. No overt tachy- or brady[[Dysrhythmia]]s. Low suspicion for [[WPW (Congenital Pre-Excitation Syndrome; Wolff-Parkinson-White)]], [[QT Interval (Segment) Prolongation]], [[HOCM (Hypertrophic Obstructive Cardiomyopathy)]], [[Brugada Syndrome]] after EKG review.
As above, patient with unchanged neurovascular exam post procedure. No [[Foreign Body]] sensation after repair but discussed possible smaller fragments being retained despite close inspection under bright field and copious irrigation with saline_. Cautious return precautions discussed w/ full understanding.
After extensive discussion with family regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time_. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Patient with nonfocal neurologic exam and with low suspicion for overt [[ICH (Intracranial Hemorrhage)]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.
Serial neuro exam without new focal neuro signs or [[AMS (Altered Mental Status)]], has been at baseline mental status; seen running and walking around ER smiling and playful. No emesis. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]]. Discussed case at length with parents and requesting to go home. Given reliability of parents (both father, mother, and grandmother at bedside with appropriate concern and interaction), low suspicion for NAT and seems reliable to monitor and bring back patient if any changes or concerns. Mutual decision to discharge home with strict return precautions.
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]].
This was assessed during the medical interview. Capacity to make one’s own medical decisions is based upon a patient’s ability to understand the decision that is being made, the possible options, the risks and benefits of those options, demonstrate understanding of this information and the ability to apply it to themselves, and ultimately the ability to communicate a decision. Capacity is dynamic over time, and the threshold for capacity is different dependent on the specific decision and its risks and benefits. Given our conversation, the patient at this time does appear to have the ability to communicate a preference to leave the hospital rather than stay and have medical workup_. The patient does understand the benefits of their decision, which include personal [[Autonomy]] and the ability to seek care elsewhere, as well as the risks, which include delay in medical workup and possible worsening of symptoms. Given their ability to reason through this decision, and the risk of leaving the hospital _, the patient does appear to have capacity at this time_. Therefore, we will respect the patient’s [[Autonomy]] to make their own decisions, which at this time is expressed as a desire for discharge.
Of note, at this time, it the patient does not seem to meet criteria for an in[[Voluntary]] hold based on grave disability. Patient is able to state a clear and viable plan for obtaining her own food, clothing, and shelter._
Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
PROGPEDSHeadTraumaReassess
Serial neuro exam without new focal neuro signs or AMS, has been at baseline mental status; seen running and walking around ER smiling and playful. No emesis. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]]. Discussed case at length with parents and requesting to go home. Given reliability of parents (both father, mother, and grandmother at bedside with appropriate concern and interaction), low suspicion for NAT and seems reliable to monitor and bring back patient if any changes or concerns. Mutual decision to discharge home with strict return precautions.
ED Sign Out
The patient’s care was signed out to Dr. * at 20:00*.
Items Pending at sign out: ***
Impression at the time of sign out: ***
Expected disposition: ***
(I spoke to the physician taking over care about the plan for this patient, but the final disposition will depend on the results of the patient’s studies/labs and condition upon re-evaluation. The original plan may alter depending on the patient’s medical needs.)
Discharge Instructions
DCAbdPain
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Abdominal Pain]]. Your evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of your current condition.
Return to the ER if your pain does not resolve within 8-12 hours or worsens. Please follow up with your primary care physician within one to two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], chest pain, difficulty breathing, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for your allergic reaction. You have been given medications including [[Steroid]], [[Epinephrine (Adrenaline)]], and [[Diphenhydramine (BENADRYL®)]] to control your swelling. You have been observed in the Emergency Department and it appears that your symptoms will not return.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience difficulty breathing or swallowing, recurrent vomiting, rashes, lip/mouth/[[Tongue]] swelling, persistent fevers or for any other concerning symptoms.
Thank you for choosing Olive-ViewUCLA for your care.
DCAbscessID
You were evaluated in the Olive View-UCLA Emergency Department for an abscess. Your abscess was incised and drained in the Emergency Department. We have inserted a loose gauze in the abscess pocket to promote drainage and applied a clean dressing over it. You will need to change the dressing every 24 hours. Please keep the areas surrounding the abscess clean and dry. Take the antibiotics prescribed to you in full as directed.
Follow up with your primary care physician within 2 days for a wound check. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, an increase in area of redness, increased tenderness/warmth around the abscess, [[Foul Smelling]] discharge from the abscess, or any other concerning symptoms.
DCAbscessNoID
You were evaluated in the Olive View-UCLA Emergency Department for an abscess. You should soak the area in warm water for 20-30 minutes 3-4 times daily. Contact your doctor when the abscess comes to a head and needs to be drained. Please keep the areas surrounding the abscess clean and dry. Take the antibiotics prescribed to you in full as directed.
Follow up with your primary care physician within 2 days for a wound check. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, an increase in area of redness, increased tenderness/warmth around the abscess, [[Foul Smelling]] discharge from the abscess, or any other concerning symptoms.
DCAMA
You have been evaluated in the Olive View-UCLA Emergency Department today. You are refusing further testing, imaging, and further admission and choosing to leave [[AMA (Against Medical Advice)]]. You were advised of your risks of leaving and understand that permanent harm, or even death, can occur from failing to follow the recommendations of the physician.
Please follow up with your primary care physician within one day. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.
Return to the Emergency Department immediately if you experience worsening or uncontrolled pain, persistent fevers, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], chest pain, [[SOB (Shortness of Breath)]], or for any other concerning symptoms.
DCAnkle
You have been evaluated in the Olive View-UCLA Emergency Department today for ankle pain. The x-ray of your ankle _.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your ankle to control your pain.
Please follow up with your primary care physician within two days as needed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.
DCAnxiety
You have been evaluated in the Olive View-UCLA Emergency Department today for your anxiety. Your symptoms have resolved in the Emergency Department.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience new or worsening anxiety, depression, thoughts of harming yourself or others, or for any other concerning symptoms.
DC[[Asthma]]
You were evaluated in the Olive View-UCLA Emergency Department today for an acute exacerbation of your [[Asthma]]. Your symptoms improved receiving an albuterol breathing treatment.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms.
DCBackPain
You were evaluated in the Olive View-UCLA Emergency Department today for [[Back Pain (Dolor)]]. Your evaluation suggests no acute abnormalities which require further intervention at this time.
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain. You should continue doing back exercises which could include going to [[Physical Therapy]].
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening [[Back Pain (Dolor)]], incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.
DCCellulitis
You have been evaluated in the Olive View-UCLA Emergency Department today for a skin infection. Please take the prescribed antibiotics as directed for the full course of the medication.
Follow up with your primary care physician within 2 days for a re-evaluation of the skin infection to make sure it has not spread and is getting better. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience an increase in area of redness, persistent fevers, increased tenderness/warmth around the skin infection, or any other concerning symptoms
DCChestPain
You have been evaluated in the Olive View-UCLA Emergency Department today for chest pain. Your evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your EKG did not show any acute changes.
Please follow up with your primary care doctor in 2 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening chest pain, palpitations, [[SOB (Shortness of Breath)]], persistent vomiting, [[Fainting]], or for any other concerning symptoms.
DCCough
You were evaluated in the Olive View-UCLA Emergency Department today for a cough. Your evaluation suggests _.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening cough, fever, [[SOB (Shortness of Breath)]], recurrent vomiting, [[Lethargy]], or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for your dental pain. Your pain has been controlled with __. Your [[PE (Physical Exam(ination))]] suggests no acute abnormalities which require further intervention at this time.
Please follow up with your [[Dentist]] tomorrow. Call to schedule an appointment with a [[Dentist]]ry clinic.
Return to the Emergency Department if you experience worsening or uncontrolled pain, fevers 100.4°F or greater, vomiting, [[Tongue]] swelling, throat swelling, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Dizziness]]. Your evaluation suggests _.
You have been prescribed _ to help relieve your symptoms. Please take your prescription as directed.
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, [[Fainting]], or for any other concerning symptoms
DC[[Dysuria]]
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take as directed in full_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
You were evaluated in the Olive View-UCLA Emergency Department today for ear pain. Your [[PE (Physical Exam(ination))]] suggests that you have an ear infection_. Please take the antibiotics in full as directed_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience [[HL (Hearing Loss; Deafness)]], discharge from your ear, headaches, fevers, recurrent vomiting, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for elbow pain. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable// reveal a fracture_.
Please use the sling for comfort_. You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with an orthopedic surgeon in about 1 week. If we referred you to the olive view specialists, please follow up with your appointment. Please call 818-364-3676 if you do not receive a call for an appointment time.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for a [[Nose Bleed (Epistaxis)]]. The bleeding was controlled in the Emergency Department and your examination reveals no active bleeding at this time.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately if you experience worsening bleeding, worsening or uncontrolled pain, difficulty breathing, or for any other concerning symptoms.
You have been evaluated in the Olive View UCLA Emergency Department today for alcohol intoxication. You are now able to walk on your own and are tolerating fluids/food.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience inability to keep down fluids, worsening or uncontrolled pain, confusion, or for any other concerning symptoms.
LA Country Drug Abuse and Prevention
http://publichealth.lacounty.gov/sapc/findtreatment.htm
Call: 800-564-6600
You were evaluated in the Olive view-UCLA Emergency Department today for eye redness. Your [[PE (Physical Exam(ination))]] suggests _.
Call (818)-364-3538 to schedule an appointment with the eye specialist within one week for a repeat [[Eye Exam]]._
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience discharge from your eye, worsening eye redness, [[Eye Pain]], vision changes, headache, fever, vomiting, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for finger pain. Your evaluation, including [[PE (Physical Exam(ination))]] and x-ray, has revealed that you have a fracture of your _// no evidence of any acute fractures or dislocations_. Your finger was splinted in the Emergency Department_. Keep the splint clean and dry.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience any new or worsening finger pain, [[Numbness]], weakness, [[Discoloration]], fevers, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for foot pain. The x-ray of your foot shows _.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your foot to control your pain.
Please follow up with your primary care physician within two days as needed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with a podiatrist in about 1 week. You can find an podiatrist by calling (818) 364-3676.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for your injury while _. Your evaluation, including an x-ray of your _, have revealed a fracture of your _. Your __has been splinted in the ER.
Please rest, ice, and elevate your __to control pain and inflammation. Please take Tylenol of Motrin as needed for pain. Take vicodin for as needed for severe pain. Do not drive or operate heavy machinery while taking vicodin.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with an orthopedic surgeon in about 1 week. You can go to your primary care doctor or follow up with the referral we have given you. Please call (818) 364-3676 if you do not receive a call for your appointment time.
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Abdominal Pain]]. Your evaluation suggests that your pain is due to [[Gallstone (Cholelithiasis)]]. It is not emergent at this time but it is recommended that you make an appointment at a surgery clinic to be evaluated to have your [[Gallbladder]] removed.
We will give you a referral to general surgery at olive view. They will call you with an appointment time in the future to discuss elective surgery. P lease call (818) 364-3129 if you do not receive an appointment date.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, fever, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], [[SOB (Shortness of Breath)]], or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for general weakness. Your evaluation, including _, were within normal limits and not suggestive of any emergent condition requiring medical intervention at this time.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for headache. Your evaluation suggests _. Your pain improved with medication.
Please control your pain by alternating Tylenol and Motrin every 4-6 hours as directed on the package.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]]/tingling, weakness, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your evaluation suggests _.
You will likely feel a little worse tomorrow due to the trauma please rest and control your pain by alternating Tylenol and Motrin every 4-6 hours as directed on the package. You should avoid contact sports, running, playing video games and studying for long periods of time.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience [[Severe Headache]], vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Hemorrhoid (Pile)]]. You were given a prescription for topical cream_ and stool softeners to help with your symptoms. Use a [[Sitz Bath]] and rest to help control your pain (instructions can be found at http://www.webmd.com/digestive-disorders/sitz-bath). Drink plenty of fluids.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, worsening bleeding in your stool, recurrent vomiting, blood in vomit, [[SOB (Shortness of Breath)]], fevers or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for pain secondary to your hernia. Your evaluation suggests that you do not need any emergent surgery to repair your hernia today.
Please follow up with your primary care physician within the next week. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please arrange to see a general surgeon for elective surgery through your primary care doctor. If you do not have a primary care doctor, we will refer to surgery here, you will receive a phone call for an appointment time. If you do not get an appointment, you can call Outpatient Surgery Clinic, (818) 364-3129.
Return to the Emergency Department if you experience worsening pain, fever, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], [[SOB (Shortness of Breath)]], or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for toe pain from an ingrown toe nail.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your foot to control your pain, as well as soak your foot in water 1-2 times daily and place an antibiotic ointment in the corner of your toenail and cover with a bandage.
Please follow up with a podiatrist to treat your ingrown toenail. You can call 818- 364- 3676 to find a podiatry appointment at Olive View-UCLA.
Return to the Emergency Department if you experience worsening pain, worsening swelling, fevers 100.4°F or greater, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.
DCKidneyStone
You have been evaluated in the Olive View-UCLA Emergency Department today for a [[Nephrolithiasis ((Kidney; Renal) Stone(s))]]. The stone will pass on its own and will be expelled in the urine. Please use the strainer as directed to strain your urine until your stone passes. Please read the information provided to you on discharge.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, fever, painful urination, [[Blood In Urine]], weakness, chest pain, difficulty breathing or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for knee pain. The x-ray of your knee shows_.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your leg to control your pain.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, or any other concerning symptoms.
You were evaluated in the Olive View-UCLA Emergency Department today for a laceration of your _. Your laceration was closed with sutures_ in the Emergency Department. Please keep the area surrounding the laceration clean and dry.
Please follow up with your primary care physician in 7-10 days to get your sutures removed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, [[Numbness]], tingling, or any other concerning symptoms.
DCLegSwelling
You were evaluated in the UCLA Emergency Department today for leg swelling. Your [[PE (Physical Exam(ination))]] and _ reveal _.
Please rest and keep your leg elevated. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience [[SOB (Shortness of Breath)]], chest pain, palpitations, nausea/vomiting or any other concerning symptoms.
STROKE – CODE ACTIVATION
MDM
This * patient presents with symptoms concerning for acute CVA versus TIA.*. Other items on the differential include dissection, AMI, [[↓Glucose↓]] or other metabolic derangement such as hepatic/[[Uremic [[Encephalopathy (Altered (Level Of) Consciousness)]]]], medication side effect, or post-ictal [[Todd Paralysis]]. However, presentation most concerning for a CVA. EKG without evidence of STEMI or [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]], fingerstick BS not hypoglycemic, and clinical picture does not suggest other stroke mimic. Plan to workup for acute CVA / TIA.
Plan: Code stroke protocol, MRI/MRA stroke protocol, stroke labs, Neurology stroke consult
January 3, 2018 Tagged code stroke, CVA, MDM, neuro, stroke, tia Leave a comment
SYNCOPE – ADMIT
MDM
This * patient presents with symptoms consistent with syncope, most likely due to *. Differential diagnosis includes *reflex syncope (i.e. [[Vasovagal Syncope]]). Low suspicion for orthostatic syncope given lack of dehydration, no evidence of acute life threatening [[Hemorrhage]]. Presentation not consistent with [[Seizure]] given short time course, no postictal state, no seizure activity. Low suspicion for acute neurologic catastrophes to include ICH given lack of trauma, risk factors for bleeding diatheses. Low suspicion for vascular catastrophes to include PE, [[Thoracic Aortic Dissection]], AAA rupture. Presentation not consistent with acute life threatening [[Arrhythmia (Abnormal Rhythm)]], [[Structural Heart (Disease; Defect; Problem)]], electrical conduction abnormalities, or ACS (HEART score: *). However, given age, cardiovascular risk factors, history & physical, will workup and admit to telemetry.
Plan: labs, troponin, CXR, EKG, serial reassessment
January 3, 2018 Tagged admit, MDM, neuro, syncope Leave a comment
SYNCOPE – LOW RISK
MDMJanuary 3, 2018 Tagged low risk, MDM, neuro, syncope Leave a comment
UPPER [[Gastrointestinal Bleed]] – GENERAL
MDM
This patient with * presents with symptoms concerning for acute, upper [[Gastrointestinal Bleed]], likely secondary to *.
Differential diagnoses includes [[PUD (Peptic Ulcer Disease)]] (PUD = most common) versus less likely [[Gastritis]] versus [[Mallory Weiss Tear (Syndrome)]] versus AVM. Presentation not consistent with esophageal or gastric [[Variceal Bleed]] or [[Spontaneous Esophageal Rupture]]’s syndrome. Presentation not consistent with other etiologies upper [[Gastrointestinal Bleeding]] at this time. No [[Red Flag(s)]] features or high risk bleeding. No evidence of [[Hemorrhagic Shock]]. Glasgow-Blat[[CHF (Congestive v[[HF (Heart Failure)]])]]ord Bleeding (GBS) score: *. Based on this well validated study, the patient can safely be discharged for outpatient therapy // is “high risk” for needing a medical intervention to include transfusion, [[Endoscopy]] or surgery. Plan to check labs to evaluate the extent of bleeding, including H/H. Will initiate treatment with PPI. No indication for [[Octreotide (SANDOSTATIN)]] or antibiotics given low likelihood of [[Variceal Bleed]] from [[PH (Portal [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]])]] and [[Cirrhosis]].* No indication for abdominal imaging at this time.
Plan: labs, LFTs, close [[Hemodynamic Monitoring]], serial reassessment, PPI therapy, Octrotide/CTX***
January 3, 2018 Tagged general, gi, MDM, UGIB, [upper [[Gastrointestinal Bleed]]](https://natedotphrase.com/tag/upper-gi-bleed/) Leave a comment
UTI – LOW RISK
This * patient presents with symptoms consistent with acute [[Uncomplicated Cystitis]]. No systemic symptoms. Not septic. Well appearing. Low suspicion for acute [[Pyelonephritis]] given lack of fever, CVAT, or systemic features. Low suspicion for [[Nephrolithiasis ((Kidney; Renal) Stone(s))]] or infected stone. *ICON negative; not consistent with pregnancy, including ectopic. No indication for labs or imaging at this time.
Plan: UA, UCx, antibiotics***
January 3, 2018 Tagged cystitis, gu, low risk, [[UTI (Urinary Tract Infection)]]](https://natedotphrase.com/tag/urinary-tract-infection/), uti Leave a comment
[[Vertigo]] – LOW RISK
MDM
This patient presents with [[Dizziness]], most consistent with a peripheral cause, likely [[Vertigo]]. Differential diagnoses includes: BPPV versus labrynthitis.*** No [[Red Flag(s)]] features for [[Central Vertigo]] to include gradual onset, vertical/bidirectional or nonfatigable nystagmus, focal neurologic findings on exam (including inability to ambulate). Presentation not consistent with an acute [[CNS (Central Nervous System) Infection]], vertebral [[Basilar (Artery) Insufficiency]], [[Cerebellar Hemorrhage]] or [[Infarction]], [[Intracranial Mass]] or bleed, [[Temporal Lobe(s)]] epilepsy, [[MS (Multiple Sclerosis; Encephalomyelitis Disseminata)]], trauma, complex [[Migraine (Headache)]] headache. Other acute, emergent causes of [[Vertigo]] are unlikely given at this time. No indication for head imaging at this time.
Plan: [[Meclizine (ANTIVERT)]], supportive care, serial reassessment
[January 3, 2018](https://natedotphrase.com/2018/01/03/[[Vertigo]]-mdm-low-risk/) Tagged [[[Dizziness]]](https://natedotphrase.com/tag/[[Dizziness]]/), low risk, MDM, neuro, [[Vertigo]]](https://natedotphrase.com/tag/[[Vertigo]]/) [Leave a comment](https://natedotphrase.com/2018/01/03/[[Vertigo]]-mdm-low-risk/#respond)
VIRAL URI – DISCHARGE
MDM
This * patient presents with symptoms suspicious for likely viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]]. Differential includes [[Bacterial Pneumonia]], [[Sinusitis]], allergic rhinitis, *. Do not suspect underlying cardiopulmonary process. I considered, but think unlikely, dangerous causes of this patient’s symptoms to include ACS, [[CHF (Congestive v[[HF (Heart Failure)]])]] or [[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]]s, pneumonia, [[PTX (Pneumothorax)]]. Patient is nontoxic appearing and not in need of emergent medical intervention.
Plan: reassurance, reassessment, over the counter medications, discharge with PCP followup
November 28, 2018 Leave a comment
VIRAL URI – DISCHARGE
MDM
This * patient presents with symptoms suspicious for likely viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]]. Differential includes [[Bacterial Pneumonia]], [[Sinusitis]], allergic rhinitis, *. Do not suspect underlying cardiopulmonary process. I considered, but think unlikely, dangerous causes of this patient’s symptoms to include ACS, [[CHF (Congestive v[[HF (Heart Failure)]])]] or [[Exacerbation Of [[COPD (Chronic Obstructive Pulmonary Disease)]]]]s, pneumonia, [[PTX (Pneumothorax)]]. Patient is nontoxic appearing and not in need of emergent medical intervention.
Plan: reassurance, reassessment, over the counter medications, discharge with PCP followup
November 28, 2018 Leave a comment
HPI
HPI5Ds
No [[Dysphagia]], [[Dysarthria]], diplopia. No difficulty with gait or coordination.
HPIAMS
_ presents with [[AMS (Altered Mental Status)]].
Patient’s history is notable for: _.
Patient was brought in by _. Patient was found at _.
Denies ingestion. _
Patient without history of similar in past._
Glucose in field was _.
Denies seizure history. No seizure activity witnessed. Denies incontinence or [[Tongue]] biting._
Denies falls or recent trauma._
HPIAbdominalPain
Patient presents with [[Abdominal Pain]].
Patient’s history is notable for: _.
Patient first noted the [[Abdominal Pain]] _. Pain is at diffuse/RUQ/LUQ/RLQ/[[LLQ (Left Lower Quadrant)]]/epigastric _. Discomfort is described as a pressure/sharp/dull_ sensation without/with _ radiation to groin/back. Patient has had this [[Abdominal Pain]] before_. Pain is nonexertional and not positional_.
Pain is not associated with food_. Pain is alleviated by _ and worsened by _.
Patient denies past abdominal surgeries. Last [[Bowel Movement]] was _. Endorses flatus._
Denies nausea or vomiting. Able to tolerate PO without difficulty._
Denies [[Diarrhea]], [[BRBPR (Hematochezia; Bright Red Blood Per Rectum)]], or [[Melena (Dark Tarry Stool)]]._
Denies [[Dysuria]] or [[Hematuria]]. Denies flank pain. _
Denies recent travel._
Denies recent antibiotics or hospitalizations._
HPIBackPain
Patient has no history of malignancy, active or distant history. Patient is not less than 16 or greater than 50. Patient has no unexplained weight loss. No recent fevers, rigors, [[Malaise]], or recent infection. No history of [[IVDU; IVDA (IV (Intravenous) Drug Abuse)]] or skin-popping. Patient does not have any [[Saddle Anesthesia]]/[[Perianal]] sensory loss or complaining of [[↓ Rectal Tone]]. Patient does not have [[Urinary Retention]] or inability to control urine from overflow. Patient has no tenderness overlying spinous process. Patient has normal gait and able to walk on heels/ toes. Patient has no focal weakness on examination. Patient does not have hyperreflexia on examination.
HPIChestPain
Patient has a history significant for _.
[[Chest Discomfort]] is described as a pressure/sharp/dull sensation without/with radiation to neck/arm/back. Patient has had this chest pain before. Chest pain is nonexertional. Chest pain started at _ and has been intermittent/constant/progressive/nonprogressive. Patient last chest pain was at _.
Chest pain is non-pleuritic and not positional_. Chest pain is not associated with food.
Patient endorses the following symptoms: _
Patient denies any associated symptoms, including [[Near Syncope]], syncope, palpitations, [[SOB (Shortness of Breath)]], nausea, vomiting, [[Sweating]]._
Denies [[Orthopnea ([[SOB (Shortness of Breath)]] (dyspnea) That Occurs When Lying Flat)]], PND, or LEE.
Denies upper respiratory symptoms or productive cough.
Patient denies any [[Lower Extremity Edema]], pain, asymmetry, or swelling.
Denies prior [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]/PE or history of malignancy or known [[(Hypercoagulable; Prothrombotic) (State; Disorder; Condition) (Thrombophilia)]].
Patient has had no decline in their exercise tolerance.
Patient denies any tearing chest pain.
Patient denies any early family history of cardiac death or MI.
Patient has been compliant with home medications
HPIPEDSRash
fully vaccinated, otherwise healthy M_ who presents with rash for past day_. Rash started centripetally_ and is scattered papular mildly pruritic over chest and face_ with no oral involvement. Patient with mild URI symptoms several days prior and fever, now resolved. Patient otherwise at baseline with baseline mental status, activity level, UOP and PO intake intact. Denies sick contacts. Denies other family members with rash. Denies discharge, fevers, recent travel/hospitalizations/antibiotics.
HPIPEDSURI
vaccinations up to date_, full term, otherwise healthy boy_ who presents with upper respiratory symptoms including a non[[Productive Cough]], congestion and [[Coryza]] for 2-3_ days. Patient also with fever for 2 days_. Endorse sick contact_ in father with similar symptoms. Stable UOP. No nausea or vomiting. Normal PO intake. No rashes. At baseline mental status and activity level without [[Lethargy]]. No recent travel. No overt [[Abdominal Pain]], headache, ear pain, or [[SOB (Shortness of Breath)]]. No increase in respiratory effort.
HPI
[[Pre-Eclampsia]]
Patient is asymptomatic currently and at baseline_. Patient was seen in clinic today by primary OB and patient had two mildly [[↑↑↑ [[BP (Blood P (Pressure))]] ↑↑↑]] readings_. Patient denies known personal and family history of [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]]_. Denies headache or vision changes, including [[Photophobia]], [[Blurred Vision]], and [[Scotoma(ta); [[Visual Field(s)]] (Defect; Deficit)]]. Denies [[Abdominal Pain]], nausea, vomiting, focal weakness or parasthesias. Endorses persistent, although stable, intermittent [[Lower Extremity Edema]] without further asymmetry or pain. Denies chest pain or [[SOB (Shortness of Breath)]]. Denies PND or DOE. Denies oozing with brushing teeth or new easy bruising. Denies [[Vaginal Bleeding]], loss of fluid, [[Contractions]]. Endorses stable and active movement of fetus.
HPIPsych
_who presents with SI_.
Patient’s history is notable for: _. Patient was brought in voluntarily/by family/by police_. A temporary hold was/was not placed prior to arrival. _
Patient was in normal state of health until approximately _ days ago. At this time, patient noted _. Patient came in today due to _.
Patient endorses SI with plan to _.
Denies previous suicide attempt. Patient has been compliant with his medications._
Patient denies any ingestions including tylenol or aspirin._
Denies [[Illicit (Substance; Drug) (Use)]] including [[IVDU; IVDA (IV (Intravenous) Drug Abuse)]], [[Amphetamines]], [[Marijuana (Cannabis)]], or alcohol. _
Patient is seen by Dr. _.
Denies previous hospitalizations._
Denies [[Hallucinations]], auditory or visual._
Denies HI/HA._
Patient is able to perform daily functions and contracts to safety._
HPISOB
presents with [[SOB (Shortness of Breath)]]. Patient’s history is significant for _.
Patient first noticed increased shortness of breath _. [[SOB (Shortness of Breath)]] has been progressive_. Denies alleviating or exacerbating factors_. Denies similar episodes in past. Denies changes in position. Denies pleurisy.
Denies chest pain, [[Abdominal Pain]], nausea or vomiting. Denies fevers._
Denies home oxygen requirement or increase in oxygen requirement._
Denies recent travel. Denies sick contacts_.
Denies upper respiratory symptoms, including [[Productive Cough]], [[Hematemesis]], [[Sore Throat (Pharyngitis)]] or runny nose._
Denies [[Lower Extremity Edema]], swelling, asymmetry or pain._
Denies history of [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]/PE. Denies known malignancy or [[(Hypercoagulable; Prothrombotic) (State; Disorder; Condition) (Thrombophilia)]].
Denies smoking or OCP use.
Patient has been compliant with home medications.
HPIURI
otherwise healthy p/w four_ days of productive cough without [[Hemoptysis]], mild chills now resolved, no overt fever, also associated with concurrent [[Coryza]] and congestion_. Denies chest pain or [[SOB (Shortness of Breath)]]. Denies LE edema, asymmetry or pain. Denies AP, n/v. Denies headache, fevers or chills. Denies [[Orthopnea (Shortness of Breath (dyspnea) That Occurs When Lying Flat)]] or PND. + sick contact also with similar [[Constellation]] of symptoms. No travel.
SCORE
.HEARTSCORE
http://www.mdcalc.com/heart-score-for-major-cardiac-events/
Upon calculating the patient’s HEART score, they were found to have a score of 0-3, which indicates low risk, so the patient can be safely discharged with the understanding that they need to make an appointment with a primary care doctor to be referred for a stress test within the next 48-72 hours, or if they cannot arrange that they are to return to the ED, or sooner than that if they have any changing, persistent, or worsening symptoms.
In the studies referenced below, the patients in the low risk group were discharged and found to have a 0.9-1.7% change of having a major adverse cardiac event (defined as revascularization, myocardial [[Infarction]], or all-cause mortality) within 6 weeks when studied both retrospectively and prospectively.
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008 Jun;16(6):191-6. PMID: 18665203
Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. PMID: 23465250.
Resources
.HEARTSCORE
http://www.mdcalc.com/heart-score-for-major-cardiac-events/
Upon calculating the patient’s HEART score, they were found to have a score of 0-3, which indicates low risk, so the patient can be safely discharged with the understanding that they need to make an appointment with a primary care doctor to be referred for a stress test within the next 48-72 hours, or if they cannot arrange that they are to return to the ED, or sooner than that if they have any changing, persistent, or worsening symptoms.
In the studies referenced below, the patients in the low risk group were discharged and found to have a 0.9-1.7% change of having a major adverse cardiac event (defined as revascularization, myocardial [[Infarction]], or all-cause mortality) within 6 weeks when studied both retrospectively and prospectively.
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008 Jun;16(6):191-6. PMID: 18665203
Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. PMID: 23465250.
Resources
.NIHSSMOD
NIH Stroke Scale:
Interval: {NIHSS interval:17994}
Time: {Time; 0100-2400:14903} ***
Person Administering Scale: ***
1a. Level of consciousness: {exam; consciousness neuro:31423}
1b. LOC questions: (month; age) * 0 – answers both questions correctly * 1 – one question correctly *** 2 – neither question correctly
1c. LOC commands: [open/close eyes; grip/ release hand or other 1-step command] {Loc commands neuro:31401}
2. Best Gaze: [test horizontal only. Isolated peripheral [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]],4,6 palsy =1] {exam; best gaze neuro:31402}
3. Visual: [upper & lower VF quadrants] {Visual neuro:31403}
4. [[Facial Palsy]]: [show teeth, raise eyebrows, close eyes] {Exam; neuro facial palsy:31404}
5a. Motor left arm: [extend arms] {Motor arm:27865}
5b. Motor right arm: {Motor arm:27865}
6a. Motor left leg: [hold 30 degrees supine] {Motor leg:27866}
6b. Motor right leg: [hold 30 degrees supine] {Motor leg:27866}
7. Limb Ataxia: [w/ eyes open. (B) Finger to nose; (B) heel to shin. ‘0’ if paralyzed or does not understand] {Limb ataxia neuro:31406}
8. Sensory: [to pinprick. If coma-> 2] {SENSORY:18028}
9. Best Language: [describe picture; name items in picture; read sentences] {exam; best language neuro:31408}
10. [[Dysarthria]]:[read or repeat words] {[[Dysarthria]] neuro:31409}
11. Extinction and Inattention: {findings; extinction neuro:31410}
Total: {0-42:17997}
Note:
A patient with a completely normal neurological exam and normal mental status
will have an NIHSS of 0. The maximum recordable [[NIHSS Score]] is 42. However,
since acute [[Ischemic Stroke]] causes unilateral paralysis and [[Blindness]], the maximum
score actually is 31 for a stroke patient with complete hemiparesis, [[Hemianopia]],
hemineglect, and aphasia.
Patients with an [[NIHSS Score]] greater than 15-20 are considered to have a severe
stroke clinically.
.NIHSSMOD
NIH Stroke Scale:
Interval: {NIHSS interval:17994}
Time: {Time; 0100-2400:14903} ***
Person Administering Scale: ***
1a. Level of consciousness: {exam; consciousness neuro:31423}
1b. LOC questions: (month; age) * 0 – answers both questions correctly * 1 – one question correctly *** 2 – neither question correctly
1c. LOC commands: [open/close eyes; grip/ release hand or other 1-step command] {Loc commands neuro:31401}
2. Best Gaze: [test horizontal only. Isolated peripheral [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]],4,6 palsy =1] {exam; best gaze neuro:31402}
3. Visual: [upper & lower VF quadrants] {Visual neuro:31403}
4. [[Facial Palsy]]: [show teeth, raise eyebrows, close eyes] {Exam; neuro facial palsy:31404}
5a. Motor left arm: [extend arms] {Motor arm:27865}
5b. Motor right arm: {Motor arm:27865}
6a. Motor left leg: [hold 30 degrees supine] {Motor leg:27866}
6b. Motor right leg: [hold 30 degrees supine] {Motor leg:27866}
7. Limb Ataxia: [w/ eyes open. (B) Finger to nose; (B) heel to shin. ‘0’ if paralyzed or does not understand] {Limb ataxia neuro:31406}
8. Sensory: [to pinprick. If coma-> 2] {SENSORY:18028}
9. Best Language: [describe picture; name items in picture; read sentences] {exam; best language neuro:31408}
10. [[Dysarthria]]:[read or repeat words] {[[Dysarthria]] neuro:31409}
11. Extinction and Inattention: {findings; extinction neuro:31410}
Total: {0-42:17997}
Note:
A patient with a completely normal neurological exam and normal mental status
will have an NIHSS of 0. The maximum recordable [[NIHSS Score]] is 42. However,
since acute [[Ischemic Stroke]] causes unilateral paralysis and [[Blindness]], the maximum
score actually is 31 for a stroke patient with complete hemiparesis, [[Hemianopia]],
hemineglect, and aphasia.
Patients with an [[NIHSS Score]] greater than 15-20 are considered to have a severe
stroke clinically.
.TPACONTRAINDICATIONS
[[Exclusion Criteria]]
— Significant head trauma or prior stroke in previous 3 months
— Symptoms suggest [[SAH (Subarachnoid Hemorrhage)]]
— History of previous [[ICH (Intracranial Hemorrhage)]]
— Intracranial neoplasm, [[AVM (Arteriovenous Malformation)]], or [[Aneurysm]]
— Recent intracranial or intraspinal surgery
— [[Arterial Puncture]] at noncompressible site in previous 7 days
— Elevated blood pressure (systolic >185 mm Hg or diastolic >110 mm Hg)
— Active internal bleeding
— Blood glucose concentration <50mg/dl (2.7mmol/L)
— Acute bleeding diathesis, including but not limited to: Platelet count <100 000/mm³ (In patients without history of [[Thrombocytopenia]],
treatment with IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm³.)
— [[Heparin]] received within 48 hours, resulting in abnormally elevated [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]] greater than the upper limit of normal
— Current use of anticoagulant with INR >1.7 or PT >15 seconds (In patients without recent use of oral [[Anti(-)Coagulant(s)]] or [[Heparin]], treatment with
IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT
is abnormally elevated by local laboratory standards.)
— Current use of [[DTI (Direct Thrombin Inhibitor)]]s or direct [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] inhibitors with elevated sensitive laboratory tests (such as [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]], INR, platelet
count, and ECT; TT; or appropriate [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] activity assays)
— CT demonstrates multilobar [[Infarction]] (hypodensity >1/3 cerebral hemisphere)
Relative [[Exclusion Criteria]]
Recent experience suggests that under some circumstances—with careful consideration and weighting of risk to benefit—patients may receive
fibrinolytic therapy despite 1 or more relative contraindications. Consider risk to benefit of IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] administration carefully if any of these relative
contraindications are present:
— Only minor or rapidly improving stroke symptoms (clearing spontaneously)
— Seizure at onset with postictal residual neurological impairments
— Major surgery or serious trauma within previous 14 days
— Recent gastrointestinal or urinary tract [[Hemorrhage]] (within previous 21 days)
— Pregnancy
.TPACONTRAINDICATIONS
[[Exclusion Criteria]]
— Significant head trauma or prior stroke in previous 3 months
— Symptoms suggest [[SAH (Subarachnoid Hemorrhage)]]
— History of previous [[ICH (Intracranial Hemorrhage)]]
— Intracranial neoplasm, [[AVM (Arteriovenous Malformation)]], or [[Aneurysm]]
— Recent intracranial or intraspinal surgery
— [[Arterial Puncture]] at noncompressible site in previous 7 days
— Elevated blood pressure (systolic >185 mm Hg or diastolic >110 mm Hg)
— Active internal bleeding
— Blood glucose concentration <50mg/dl (2.7mmol/L)
— Acute bleeding diathesis, including but not limited to: Platelet count <100 000/mm³ (In patients without history of [[Thrombocytopenia]],
treatment with IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm³.)
— [[Heparin]] received within 48 hours, resulting in abnormally elevated [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]] greater than the upper limit of normal
— Current use of anticoagulant with INR >1.7 or PT >15 seconds (In patients without recent use of oral [[Anti(-)Coagulant(s)]] or [[Heparin]], treatment with
IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT
is abnormally elevated by local laboratory standards.)
— Current use of [[DTI (Direct Thrombin Inhibitor)]]s or direct [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] inhibitors with elevated sensitive laboratory tests (such as [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]], INR, platelet
count, and ECT; TT; or appropriate [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] activity assays)
— CT demonstrates multilobar [[Infarction]] (hypodensity >1/3 cerebral hemisphere)
Relative [[Exclusion Criteria]]
Recent experience suggests that under some circumstances—with careful consideration and weighting of risk to benefit—patients may receive
fibrinolytic therapy despite 1 or more relative contraindications. Consider risk to benefit of IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] administration carefully if any of these relative
contraindications are present:
— Only minor or rapidly improving stroke symptoms (clearing spontaneously)
— Seizure at onset with postictal residual neurological impairments
— Major surgery or serious trauma within previous 14 days
— Recent gastrointestinal or urinary tract [[Hemorrhage]] (within previous 21 days)
— Pregnancy
CDC Recommendations (2013)
* Kuhar DT, Henderson DK, Struble KA, et al. Updated U.S. Public Health Service guidelines for the management of [[Occupational Exposure]]s to [[HIV (Human Immunodeficiency Virus)]] and recommendations for postexposure [[Prophylaxis]]. Infect Control Hosp Epidemiol 2013;34: 875-892. Available at: http://stacks.cdc.gov/view/cdc/20711
Indications: Percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or potentially infectious body fluids, such as semen, vaginal secretions, and visibly [[Bloody Fluid]]s and reasonable suspicion that the source patient is HIV-infected.
Source Testing:
Although concerns have been expressed regarding HIV-negative sources being in the window period for seroconversion, no case of transmission involving an exposure source during the window period has been reported in the United States. Rapid HIV testing of source patients can facilitate making timely decisions regarding use of HIV PEP after occupational exposures to sources of unknown HIV status.
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Raltegravir 400 mg PO twice daily
Duration of PEP: 4 weeks
HIV Antibody Testing of Healthcare Worker
Baseline
6 weeks post-exposure
12 weeks post-exposure
6 months post-exposure
Alternatively, if the clinician is certain that a fourth-generation antibody/antigen combination assay is being used, then HIV testing could be performed at baseline, 6 weeks, and concluded at 4 months post-exposure.
PEP should be initiated as soon as possible, preferably within hours rather than days of exposure. Initiation of PEP should not be delayed while awaiting the results of a source patient’s HIV test, nor should it be delayed during consultation with experts to determine ideal PEP regimens.
Rationale:
Several clinical studies have demonstrated that HIV transmission can be significantly reduced by the post-exposure administration of [[Anti-Retroviral Therapy]] agents. A dramatic decline in vertical transmission was observed in the AIDS Clinical Trial Group (ACTG) 076 study,1 in which pregnant women and their newborns received monotherapy with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] ([[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]), and in the HIVNET 012 study,2 in which single-dose [[NVP (Nevirapine, VIRAMUNE)]] was compared with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]. A CDC retrospective [[Case Control]] study3 of [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] use after occupational HIV exposure in healthcare workers (HCWs) showed an 81% reduction in risk of [[HIV (Human Immunodeficiency Virus)]] in persons who received [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]].
Because the ultimate goals of PEP are to maximally suppress any limited viral replication that may occur and to shift the biologic advantage to the host cellular immune system to prevent or abort early infection, the Committee recommends the use of a three-drug PEP regimen for all significant risk exposures.
Relative Risks:
Estimated Per-Act Probability of Acquiring HIV From a Known HIV-Infected Source by Exposure Act
Type of Exposure Risk per 10,000 Exposures
Parenteral
Blood Transfusion 9,000
Percutaneous ([[Needle Stick]]) 30
Sexual
Receptive anal intercourse 138
Insertive anal intercourse 11
Receptive penile-vaginal intercourse 8
Insertive penile-vaginal intercourse 4
Receptive oral intercourse low
Insertive oral intercourse low
Other
Biting Negligible
Spitting Negligible
Throwing body fluids Negligible
(including semen or saliva)
http://www.cdc.gov/hiv/law/transmission.htm.
Factors that increase the risk of HIV transmission include early and late-stage [[HIV (Human Immunodeficiency Virus)]] and a high level of HIV in the blood. Factors that reduce the risk of HIV transmission include low level of HIV in the blood and the use of ART.
NYSDOH AI Recommendations (2014)
Indication: Percutaneous or [[Mucocutaneous]] exposure with blood or visibly [[Bloody Fluid]] or other potentially infectious material.
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily or [[Lamivudine (EPIVIR)]] 300 mg PO daily plus Either Raltegravir 400 mg PO twice daily or [[Dolutegravir (DOVATO)]] 50 mg PO daily
HIV Antibody Testing of Healthcare Worker
Baseline
4 weeks post-exposure
12 weeks post-exposure
When a potential [[Occupational Exposure]] to HIV occurs, every effort should be made to initiate PEP, as soon as possible, ideally within 2 hours. A first dose of PEP should be offered to the exposed worker while the evaluation is underway. In addition, PEP should not be delayed while awaiting information about the source or results of the exposed individual’s baseline HIV test.
Decisions regarding initiation of PEP beyond 36 hours post exposure should be made on a case-by-case basis with the understanding of diminished efficacy when timing of initiation is prolonged.
PROG
PROGAlcohol
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient with increased lucidity, tolerating PO, interactive with staff. [[Hemodynamic(ally) (Stability, Stable)]].
Trialed gait after several hours of observation in the ED with improvement in mental status to baseline and with stable gait. Cautious return precautions discussed w/ full understanding.
PROGAMA
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.
PROGAnkle
X-ray does not reveal any fractures, likely ankle sprain. Discussed discharge instructions with parents and return precautions. Parents expressed verbal understanding and agreement with care plan. All questions answered. Given crutches and an ankle brace. Patient is well-appearing, in no apparent distress, and vital signs stable for discharge home.
PROG[[Asthma]]
Patient reassessed and respiratory status has stabilized while in the department and appears appropriate for outpatient work up. Exam and work up not consistent w/ impending [[Respiratory Failure]] or cardiovascular collapse. Afebrile with low suspicion for acute pneumonia. Patient not hypoxic, fully ambulatory without [[Respiratory Distress]]. Medications refilled and strict return precautions discussed.
PROGECG
EKG reviewed, no overt evidence of contiguous ST segment elevations, low suspicion for acute MI. No overt tachy- or brady[[Dysrhythmia]]s. Low suspicion for [[WPW (Congenital Pre-Excitation Syndrome; Wolff-Parkinson-White)]], [[QT Interval (Segment) Prolongation]], [[HOCM (Hypertrophic Obstructive Cardiomyopathy)]], [[Brugada Syndrome]] after EKG review.
PROGLacRepair
As above, patient with unchanged neurovascular exam post procedure. No [[Foreign Body]] sensation after repair but discussed possible smaller fragments being retained despite close inspection under bright field and copious irrigation with saline_. Cautious return precautions discussed w/ full understanding.
PROGHeadCTMDM
After extensive discussion with family regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time_. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Patient with nonfocal neurologic exam and with low suspicion for overt [[ICH (Intracranial Hemorrhage)]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.
PROGHeadTraumaPeds
Serial neuro exam without new focal neuro signs or [[AMS (Altered Mental Status)]], has been at baseline mental status; seen running and walking around ER smiling and playful. No emesis. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]]. Discussed case at length with parents and requesting to go home. Given reliability of parents (both father, mother, and grandmother at bedside with appropriate concern and interaction), low suspicion for NAT and seems reliable to monitor and bring back patient if any changes or concerns. Mutual decision to discharge home with strict return precautions.
PROGReexaminationAP
Serial abdominal exam without increased tenderness; no peritoneal signs. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]].
PROGCapacity
This was assessed during the medical interview. Capacity to make one’s own medical decisions is based upon a patient’s ability to understand the decision that is being made, the possible options, the risks and benefits of those options, demonstrate understanding of this information and the ability to apply it to themselves, and ultimately the ability to communicate a decision. Capacity is dynamic over time, and the threshold for capacity is different dependent on the specific decision and its risks and benefits. Given our conversation, the patient at this time does appear to have the ability to communicate a preference to leave the hospital rather than stay and have medical workup_. The patient does understand the benefits of their decision, which include personal [[Autonomy]] and the ability to seek care elsewhere, as well as the risks, which include delay in medical workup and possible worsening of symptoms. Given their ability to reason through this decision, and the risk of leaving the hospital _, the patient does appear to have capacity at this time_. Therefore, we will respect the patient’s [[Autonomy]] to make their own decisions, which at this time is expressed as a desire for discharge.
Of note, at this time, it the patient does not seem to meet criteria for an in[[Voluntary]] hold based on grave disability. Patient is able to state a clear and viable plan for obtaining her own food, clothing, and shelter._
PROG[[CRP (C-Reactive Protein)]]
Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
PROGPEDSHeadTraumaReassess
Serial neuro exam without new focal neuro signs or AMS, has been at baseline mental status; seen running and walking around ER smiling and playful. No emesis. Patient well appearing, tolerating PO. [[Hemodynamic(ally) (Stability, Stable)]]. Discussed case at length with parents and requesting to go home. Given reliability of parents (both father, mother, and grandmother at bedside with appropriate concern and interaction), low suspicion for NAT and seems reliable to monitor and bring back patient if any changes or concerns. Mutual decision to discharge home with strict return precautions.
PROGSignOut
ED Sign Out
The patient’s care was signed out to Dr. * at 20:00*.
Items Pending at sign out: ***
Impression at the time of sign out: ***
Expected disposition: ***
(I spoke to the physician taking over care about the plan for this patient, but the final disposition will depend on the results of the patient’s studies/labs and condition upon re-evaluation. The original plan may alter depending on the patient’s medical needs.)
Discharge Instructions
MDM
MDM – AKI/DEHYDRATION
MDM
Mild, Discharge:
This patient presents with generalized weakness and fatigue likely secondary to dehydration.
Suspect [[AKI, ARF (Acute (Renal Failure; Kidney Injury))]] of prerenal origin.
Doubt intrinsic [[Renal Dysfunction]] or obstructive nephropathy.
Considered alternate etiologies of the patient’s symptoms including infectious processes, severe metabolic derangements or [[Electrolyte Abnormality]], [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]/ACS, [[HF (Heart Failure)]], and intracranial/central processes but think these are unlikely given the history and [[PE (Physical Exam(ination))]].
Plan: labs, ***fluid resuscitation, pain/nausea control, reassessment
MDM – [[Asthma]], MILD (PEDS)
MDM, Peds
Differential Diagnosis: Cough, [[Wheez(-e -es; -ing)]], [[Asthma Exacerbation]], pneumonia, seasonal allergies, viral syndrome, [[PTX (Pneumothorax)]].
Rationale: Given the history of cough, difficulty breathing, [[Wheez(-e -es; -ing)]] and history of [[Asthma]], the patient’s symptoms may be attributed to either viral syndrome, pneumonia, acute [[Asthma Exacerbation]] or [[PTX (Pneumothorax)]]. Most likely, this represents an acute [[Asthma Exacerbation]].
1) STAT bronchodilator therapy and [[Steroid]] will be given, with re-assessments between nebulized treatments.
2) If worsening or persistent symptoms occur, the patient may require critical care management or admission to the hospital.
MDM – BICEPS TENDON PROBLEM
MDM, [[PE (Physical Exam(ination))]]
This _ presents with upper arm pain and exam findings suspicious for a [[Biceps Tendon Rupture]]. Differential includes [[Bursitis]], muscle strain, partial tear, fracture, and elbow pathology. Neurovascularly intact distal to the injury.
Plan: plain films, urgent orthopedic referral, [[Pain Control]], reassessment, anticipating discharge
PEARLS:
– Classic mechanism for [[Biceps Tendon Rupture]]:
— FOOSH – proximal rupture
— Elbow forced straight against resistance – distal
– Exam: “[[Popeye Sign]]” from rupturing of the long head of the biceps. Probably will be able to still flex a little if it’s proximal.
– If they have a distal rupture, they will have marked ecchymosis over the AC and marked weakness on flexion
– Hook test: you should be able to get about 1 cm under the biceps tendon with your finger as a ‘hook’
Proximal ruptures are usually managed nonop; distal ruptures require near-term urgent ortho f/u.
January 8, 2019 Tagged msk, ortho Leave a comment
MDM – BICEPS TENDON PROBLEM
MDM, [[PE (Physical Exam(ination))]]](https://natedotphrase.com/tag/physical-exam/)
This _ presents with upper arm pain and exam findings suspicious for a [[Biceps Tendon Rupture]]. Differential includes [[Bursitis]], muscle strain, partial tear, fracture, and elbow pathology. Neurovascularly intact distal to the injury.
Plan: plain films, urgent orthopedic referral, [[Pain Control]], reassessment, anticipating discharge
PEARLS:
– Classic mechanism for [[Biceps Tendon Rupture]]:
— FOOSH – proximal rupture
— Elbow forced straight against resistance – distal
– Exam: “[[Popeye Sign]]” from rupturing of the long head of the biceps. Probably will be able to still flex a little if it’s proximal.
– If they have a distal rupture, they will have marked ecchymosis over the AC and marked weakness on flexion
– Hook test: you should be able to get about 1 cm under the biceps tendon with your finger as a ‘hook’
Proximal ruptures are usually managed nonop; distal ruptures require near-term urgent ortho f/u.
January 8, 2019 Tagged msk, ortho Leave a comment
MDM – CELLULITIS
Uncategorized
presents with initial presentation of local erythema, warmth, swelling to for ___ days.
Sensitivity/pain to [[Light Touch]] around the erythematous area.
No lymphangitic spread visible and no fluid pockets or fluctuance c/f abscess noted.
Low c/f [[Osteomyelitis]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].
No immune compromise, [[Bullae]], pain [[Out of proportion]], or rapid progression c/f [[NF (Necrotizing Fasciitis)]].
In ED: Erythema outlined
Rx: [[Cephalexin (KEFLEX)]] 500mg PO q6hrs
Disposition: No evidence of serious bacterial illness requiring admission for [[[[IV (Intravenous)]] Antibiotics]]. Nontoxic appearing, VSS. Low risk for treatment failure based on history. Will discharge home with PO antibiotics and return precautions discussed at bedside.
MDM – CELLULITIS (DC)
Uncategorized
This patient presents with initial presentation of local erythema, warmth, swelling concerning for cellulitis.
Sensitivity/pain to [[Light Touch]] around the erythematous area.
No lymphangitic spread visible and no fluid pockets or fluctuance c/f abscess noted.
Low c/f [[Osteomyelitis]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].
No immune compromise, [[Bullae]], pain out of proportion, or rapid progression c/f [[NF (Necrotizing Fasciitis)]].
In ED: Erythema outlined
Rx: [[Cephalexin (KEFLEX)]] 500mg PO q6hrs,_
Disposition: No evidence of serious bacterial illness requiring admission for [[[[IV (Intravenous)]] Antibiotics]]. Nontoxic appearing, VSS. Low risk for treatment failure based on history. Will discharge home with PO antibiotics and return precautions discussed at bedside.
January 23, 2019 Leave a comment
MDM – CELLULITIS (DC)
Uncategorized
This patient presents with initial presentation of local erythema, warmth, swelling concerning for cellulitis.
Sensitivity/pain to [[Light Touch]] around the erythematous area.
No lymphangitic spread visible and no fluid pockets or fluctuance c/f abscess noted.
Low c/f [[Osteomyelitis]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].
No immune compromise, [[Bullae]], pain [[Out of proportion]], or rapid progression c/f [[NF (Necrotizing Fasciitis)]].
In ED: Erythema outlined
Rx: [[Cephalexin (KEFLEX)]] 500mg PO q6hrs,_
Disposition: No evidence of serious bacterial illness requiring admission for [[[[IV (Intravenous)]] Antibiotics]]. Nontoxic appearing, VSS. Low risk for treatment failure based on history. Will discharge home with PO antibiotics and return precautions discussed at bedside.
January 23, 2019 Leave a comment
MDM – [[Diarrhea]] (LOW RISK)
MDM, Uncategorized
This patient presents with [[Diarrhea]] consistent with likely viral enteritis.
Doubt acute [[Bacterial [[Diarrhea]]]].
Considered, but think unlikely, partial SBO, [[Appendicitis]], [[Diverticulitis]], other intraabdominal infection.
Low suspicion for secondary causes of [[Diarrhea]] such as hyperadrenergic state, pheo, [[Hypoadrenalism ((Acute; Severe) (Adrenal Insufficiency; ((Addisonian; Adrenal) Crisis))]], [[Hyperthyroidism]], or sepsis.
Doubt antibiotic associated [[Diarrhea]].
Plan: PO rehydration, reassess, discharge with OTC anti[[Diarrhea]]l meds//short course antibiotics
MDM – [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]] DISCHARGE
MDM
This _ presents with leg swelling of unclear etiology, concerning for [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]] vs cellulitis. DDX includes chronic venous stasis changes, lymphedema, fracture or trauma, MSK pain, and other nonemergent causes of leg swelling. Doubt atypical presentation of [[CHF (Congestive v[[HF (Heart Failure)]])]] or other [[Volume Overload]] states. PE is low on the differential due to normal vital signs without symptoms. Low suspicion for constitutional infection or metabolic derangements.
Plan: basic labs, [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]] US, consider plain films, reassess, likely discharge
MDM – HEAD TRAUMA, NOT SICK
MDM
This _ presents with head trauma after a mechanical GLF. DDX includes MSK trauma, facial fractures, ICH or traumatic SAH, C-spine injury. Doubt other extracranial causes of injury. Considered nonmechanical causes of fall such as syncope, primary cardiopulmonary etiologies such as ACS/PE, but think these are unlikely. Will get head/face/neck CT, [[Pain Control]], C-collar, basic labs, reassess, discharge
MDM – KNEE PAIN (+)
MDM
LOW RISK
This * patient presents with knee pain, suspicious for *. Able to flex and extend although somewhat limited by pain. Considered, but doubt, tibial plateau fracture, [[Septic Arthritis]], other acute unstable fracture, or significant neuro[[Vascular Compromise]].
Plan: XR, [[Pain Control]], reassessment
HI RISK – Tibial Plateau
This * patient presents with knee pain suspicious for a tibial plateau fracture given history, exam, and mechanism. No e/o [[Compartment Syndrome]], [[Septic Arthritis]], other acute fracture. Range of motion is *. Will get plain films, consider CT, likely ortho consultation, [[Pain Control]], NWB.
PEARLS:
Knee EXTENSION is an extremely important motor finding to document. Inability to extend is a key indicator of serious pathology.
In peds, follow the medial tibial diaphysis up to the [[Epiphysis]] – it should be smooth all the way. A bump should make you suspicious for a buckle fracture; it’s frequently missed by radiology.
Proximal fibular fractures are associated with a peroneal nerve injury (you should document its status)
Tibial plateau fractures are high risk for [[Compartment Syndrome]].
Tibial spine fractures are a) associated with ACL tears and b) often missed unless you order a tunnel view plain film.
MDM – MISCELLANEOUS
Uncategorized
AMA Documentation
Capacity Assessment
Homelessness Documentation
[COVID FAQ – Discharge Instructions](https://natedotphrase.wordpress.com/2020/03/13/[[COVID; COVID-19; SARS CoV 2 (Corona Virus 19; Severe Acute Respiratory Syndrome Coronavirus 2)]]-dc-instructions-and-faq/)
April 18, 2018 Leave a comment
MDM – MISCELLANEOUS
Uncategorized
AMA Documentation
Capacity Assessment
Homelessness Documentation
COVID FAQ – Discharge Instructions
MDM – [[HHV-3; VZV ((Human) (Herpes) (Varicella) (Zoster) Virus (3); Shingles; Chicken Pox)]]
_ patient with a vesicular rash on an erythematous base in a dermatomal pattern consistent with [[HHV-3; VZV ((Human) (Herpes) (Varicella) (Zoster) Virus (3); Shingles; Chicken Pox)]]. Not immunocompromised and without signs of systemic or disseminated infection. Low suspicion for alternate etiology of rash such as SJS, drug rash, viral exanthem, or other emergent cause of rash.
Plan: [[Acyclovir (ACV, ZOVIRAX)]] 800mg 5x/day for a week, [[Gabapentin (NEURONTIN)]] and other [[Pain Control]], reassessment, likely discharge
MDM – SICK NEONATE (PEDS)
MDM, Peds
This is an ill-appearing *** who presents with [[Lethargy]].
Differential includes sepsis, [[CHD (Congenital Heart Disease (Anomaly; Disorder; Defect; Condition; Lesion; Malformation))]], [[↓ ↓ ↓ Volume (depletion), (Hypovolemia) ↓ ↓ ↓]] and [[PO2 <8 kPa (Hypox(a)emia)]] states, endocrine emergencies like CAH or [[Thyroiditis]], trauma, inborn errors of [[Metabolism]], [[Seizure]], electrolyte derangements, or intestinal catastrophe.
Given this undifferentiated sick neonate, will work up broadly, empiric [[Broad Spectrum Antibiotics]]***, trial of 10cc/kg fluid bolus, resuscitative measures and will consider early airway intervention.
Pearls: For a sick kid use THE MISFITS:
Trauma: consider FAST and CTH
– consider [[Vitamin K (Phytonadione)]] and Ca if bleeding
Heart disease, hypovolemia, hypoxia
Endocrine (CAH, [[Graves Disease (Thyrotoxicosis)]])
Metabolic – lytes
Inborn errors
Seizures
Formula mishaps
Intestinal catastrophes (volvulus, intuss, NEC)
Toxins
Sepsis
MDM – [[Sickle Cell]] PAIN CRISIS, [[Acute Chest Syndrome]], STROKE
TYPICAL [[Vaso-Occlusive Crisis]]
This patient with known [[SCD (Sickle Cell Disease)]] presents with their classic pain syndrome for a [[Vaso-Occlusive Crisis]].
Considered [[Acute Chest Syndrome]], stroke, [[Splenic Sequestration]], and other emergent complications of [[SCD (Sickle Cell Disease)]].
Considered alternate etiologies of this patient’s pain to include fracture, MSK pain, infection/abscess, and other ischemic etiologies but doubt these are likely.
Will plan for [[Pain Control]] using patient’s [[Pain Management]] plan, basic labs/[[Reticulocyte Count]], likely discharge
[[Acute Chest Syndrome]]
This patient with known SCD presents with chest/[[Back Pain (Dolor)]] consistent with [[Vaso-Occlusive Crisis]] but concerning for [[Acute Chest Syndrome]]; this presentation is different than the patient’s typical pain crisis. Considered alternate etiologies of chest pain including [[ACS (Acute Coronary Syndrome)]]s, PE, [[PTX (Pneumothorax)]] or pneumonia but think this is less likely.
Plan: labs, [[Pain Control]], fluids, low threshold to transfuse to Hb>9, CXR, discuss with [[Hematology]], likely admit
[[Splenic Sequestration]] OR STROKE
This patient with [[SCD (Sickle Cell Disease)]] presents with [[AMS (Altered Mental Status)]], highly concerning for severe range anemia or stroke.
[[Splenic Sequestration]] is also on the differential, although given this patient’s age it is quite unlikely that they still have functioning splenic tissue.
I considered, but think less likely, other etiologies of [[AMS (Altered Mental Status)]] such as infection, metabolic derangements, or ICH.
This symptom [[Constellation]] is concerning given the underlying medical comorbidities.
Plan: basic labs, [[Reticulocyte Count]], consider hemolysis labs, XR chest, neuroimaging, probable stroke code activation, neuro and [[Hematology]] consults, admit
MDM – TOE PAIN (INJURY)
MDM
This patient presents after a soft tissue injury to the toe. Considered, but doubt, acute fracture including open fracture. Low index of suspicion for a dislocation or Lisfranc injury. Doubt other acute causes of toe pain at this time.
Plan: plain films, [[Pain Control]], reassess, likely discharge with podiatry/orthopedics followup, WBAT***
MDM – TORSION/PELVIC PAIN
MDM
This female patient presents with lateralized pelvic pain, concerning for torsion. DDX includes TOA, PID, and other infectious symptoms but patient has no constitutional symptoms of infection.
Ectopic is on the differential but unlikely.
Also includes UTI, pyelo, [[Endometriosis]], adenomyosis but these are less likely.
Doubt [[Appendicitis]] or other primary gastrointestinal process.
Plan: labs, upreg, pelvic US, consder CT scan, pain and nausea control, fluid resuscitation, reassess
MDM – TRANSPLANT REJECTION
MDM
This * patient with a history of transplant, on immunosuppression, presents with * concerning for acute rejection vs infection. Differential diagnosis includes ***. I considered, but think unlikely, emergent causes of these symptoms in an immunosuppressed patient, including [[Opportunistic Infection]]s, donor-related infections such as CMV, but think these are unlikely.
Plan: basic labs, hold immunosuppression, gentle fluid resuscitation, discuss with transplant team, low threshold for [[Empiric Antibiotics]] and/or pulse dose [[Steroid]].
Pearls:
Most immunosuppression regimens include [[Steroid]] (out to about 6 months, but can be longer depending on the organ), [[[[CaN (Calcineurin)]] Inhibitor]] ([[Cyclosporin]], tacro), and an anti[[Proliferative]] med (MMF, AZA).
[[Post Transplantation]] lympho[[Proliferative]] disorder: your meds knock down your T cell lines so much that your other cell lines escape their checkpoints. Can be mild (a few extra monos) to severe [[Lymphoma]].
Immunosuppressive medications also have a lot of other organ-specific side effects:
HTN/DM
[[GERD (Gastroesophageal Reflux Disease)]]/[[Gastritis]]/[[Gastroparesis]] (from MMF, [[Steroid]]).
[[Osteoporosis (T-score: > -2.5)]] – easy fractures on the ddx
Renal: 25% will develop CKD w/in 1 year. This is from the [[[[CaN (Calcineurin)]] Inhibitor]].
Management:
get a tacro/CSA level if they are having an AKI; otherwise, not useful.
Hold immunosuppression until d/w transplant team
Give stress dose [[Steroid]] IF on [[Prednisone]].
BSA and consider [[Anti-Fungal]] especially if infection source considered to be pulmonary, or if they’ve had prior [[Fungal Infections]]
MDM – [[Vaginal Bleeding]], NONPREGNANT
MDM
This patient presents with *** days [[Vaginal Bleeding]] most likely of nonemergent etiology.
ED Workup: CBC, BMP, UA, [[B-hCG (Beta (Subunit) Human Chorionic Gonadotropin)]], Type&Screen
Based on History, Exam, and ED Workup patient’s presentation not consistent with [[EP (Ectopic Pregnancy)]], [[Molar Pregnancy]], life-threatening coagulopathy, trauma, serious bacterial infection, central process or other emergency.
Most likely, patient’s bleeding is secondary to [[Fibroid (Leiomyoma)]] or other non-emergent cause of [[AUB (Abnormal Uterine Bleeding)]].
Disposition: Will discharge home with return precautions and instruction for prompt OBGYN follow up.
*courtesy tydotphrase.wordpress.com
MDM – VOMITING W VPS (PEDS)
MDM, Peds
Differential diagnosis includes VPS malfunction or infection producing [[↑ ↑ ↑ ICP (Intracranial Pressure) ↑ ↑ ↑]]. Other dagnerous causes of acute vomiting are also on the differential including [[Pyloric Stenosis (Gastric Outlet Obstruction, GOO)]], [[Intussusception]], [[Appendicitis]] or SBO although in this patient they are unlikely. Considered viral syndromes (URI, [[Gastritis]], [[Gastroenteritis]]) as well as other non-emergent causes of vomiting.
Given this patient’s shunt, will evaluate with shunt series // CT // limited MRI, discuss with neurosurgery for possible tap, supportive care, reassess.
MDM – WITHDRAWAL
MDM
This _ patient presents with tremulousness, vomiting, and recent ETOH abuse suspicious for withdrawal. DDx includes intoxication, other toxidromes or withdrawal states, infection, metabolic derangements. Nontoxic appearing_. Considered other causes of patient’s vital sign abnormalities including primary cardiopulmonary etiologies such as ACS, PE, PNA but think these are unlikely. Doubt acute intraabdominal process.
Plan: BZDs, fluid resuscitation, labs, monitoring, _
MDM – WRIST PAIN (PEDS)
MDM, Peds
This patient presents with wrist pain after a trauma, suspicious for a Salter-Harris fracture. Will obtain plain films to evaluate; ortho consultation for high-grade or unstable fracture patterns, pain control, reassessment. Will likely splint with follow up in ortho clinic pending reassessment.
Pearls: SALTR
Grade 1: Straight: usually can’t see on XR
Grade 2: Above the physis (away from the joint)
Grade 3: Lower – below the physis (near the joint)
Grade 4: Through – through the physis. Unstable; will need operative repair.
Grade 5: Crush/Compression injury. Rare; difficult to pick up on initial XR. Usually from axial load force to extremity. Must consult ortho ASAP.
February 19, 2019 Leave a comment
MDM – WRIST PAIN (PEDS)
MDM, Peds
This patient presents with wrist pain after a trauma, suspicious for a Salter-Harris fracture. Will obtain plain films to evaluate; ortho consultation for high-grade or unstable fracture patterns, [[Pain Control]], reassessment. Will likely splint with follow up in ortho clinic pending reassessment.
Pearls: SALTR
Grade 1: Straight: usually can’t see on XR
Grade 2: Above the physis (away from the joint)
Grade 3: Lower – below the physis (near the joint)
Grade 4: Through – through the physis. Unstable; will need operative repair.
Grade 5: Crush/Compression injury. Rare; difficult to pick up on initial XR. Usually from axial load force to extremity. Must consult ortho ASAP.
February 19, 2019 Leave a comment
MDMAMA
After extensive discussion of R/B/A per routine with patient, patient electing to leave [[AMA (Against Medical Advice)]]. As prior, risks explained to patient with understanding and full capacity. Patient encouraged to return to ED if patient decided to change mind regarding care or if any new concerning symptoms arise.
MDMANKLE
Neurovascularly intact. Query likely ankle sprain. Discussed conservative measures including rest, elevation, alternating application of ice, [[Pain Control]] and early ambulation as tolerated. No gross ankle instability. No evidence of maison-neue. Discussed follow up with PMD and given resources for ortho/sports medicine follow up as needed. Discussed strict return precautions for neurovascular insufficiency or need for repeat imaging/evaluation if pain not vastly improved in 5-7 days for possible occult fracture.
MDMAOM
Patient with likely [[AOM (Acute Otitis Media)]] given history and exam. No overt e/o [[Mastoiditis]] or [[Malignant (Necrotizing) Otitis Externa]]. Nontoxic appearing with low suspicion for intracranial extension. Tolerating PO, low suspicion for concurrent serious bacterial infection. Will discharge home with [[Amoxicillin (MOXATAG)]] (high dose), auralgan, tylenol, follow up peds_. Cautious return precautions discussed w/ full understanding.
MDMAlcohol
Patient presents with acute alcohol intoxication without evidence of co-ingestion or trauma per history and exam. Will observe patient in ED with frequent monitoring and reassessment. Plan to PO trial, reassess mental status, and assess gait when more stable. No evidence of withdrawal currently.
MDMAllergicDermatitis
Patient with rash likely allergic or contact dermatitis in nature given history, temporal nature and appearance. No mucous membrane involvement with low suspicion for SJS/TEN. No [[Wheez(-e -es; -ing)]] or difficulty breathing with low suspicion for systemic involvement. Unclear trigger but discussed close monitoring for progression. Will prescribe single dose of steroid given extent of rash and [[Hydrocortisone (Synthetic Cortisol; CORTAID)]] cream_. Cautious return precautions discussed w/ full understanding. No overt e/o superinfection. Prompt follow up with primary care physician discussed.
MDMAnticholingericIngestion
with [[AMS (Altered Mental Status)]] and ingestion of multiple medications as above_. Patient appearing dry (dry MM, anhidrotic), tachycardic (sinus on EKG with largely normal intervals), flushed peripherally with [[←←← Pupil →→→]] and delirium with high suspicion for [[Anti-Cholinergic]] component, potentially from _. Given [[Hyperthermia]], likely secondary to anhydrotic hyperthermia and less likely [[Cerebritis; Encephalitis]] or [[CNS (Central Nervous System) Infection]] given exam and history, will start with evaporative cooling measures. Given [[Myoclonus]] and agitation, will give [[Benzodiazepine]], which will also aid to prevent [[Seizure]] secondary to possible [[Na+ (Sodium; 135-145 mEq/L)]] channel blockade (no [[ECG; EKG (Electrocardiogram; Elektro-Kardiographie)]] evidence thus far) or [[AWS (Alcohol Withdrawal Syndrome)]]. Will place foley given AMS and possible [[Urinary Retention]]. Given AMS and unclear history, will obtain CT brain and C-spine to evaluate for ICH_. Given limited exam, will obtain XR chest to evaluate for concretions_. Given likely intentional overdose, will check [[Acetaminophen; (Acetyl-Para-Aminophenol, PAPA); (PARACETAMOL); (TYLENOL)]] level and provide sitter with medical detainment until formal psychiatric evaluation_. Accucheck, Chem 7, and CBC to evaluate for possible metabolic perturbances_. Seizure precautions for possible [[AWS (Alcohol Withdrawal Syndrome)]] and monitor for respiratory and mental status for _ overdose. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Finally, will contact poison control; continue fluid rehydration, trend CK given period of immobilization_. Reassess.
MDMAnticholingericIngestion
with [[AMS (Altered Mental Status)]] and ingestion of multiple medications as above_. Patient appearing dry (dry MM, anhidrotic), tachycardic (sinus on EKG with largely normal intervals), flushed peripherally with [[←←← Pupil →→→]] and delirium with high suspicion for [[Anti-Cholinergic]] component, potentially from _. Given [[Hyperthermia]], likely secondary to anhydrotic hyperthermia and less likely [[Cerebritis; Encephalitis]] or [[CNS (Central Nervous System) Infection]] given exam and history, will start with evaporative cooling measures. Given [[Myoclonus]] and agitation, will give [[Benzodiazepine]], which will also aid to prevent [[Seizure]] secondary to possible [[Na+ (Sodium; 135-145 mEq/L)]] channel blockade (no [[ECG; EKG (Electrocardiogram; Elektro-Kardiographie)]] evidence thus far) or [[AWS (Alcohol Withdrawal Syndrome)]]. Will place foley given AMS and possible [[Urinary Retention]]. Given AMS and unclear history, will obtain CT brain and C-spine to evaluate for ICH_. Given limited exam, will obtain XR chest to evaluate for concretions_. Given likely intentional overdose, will check [[Acetaminophen; (Acetyl-Para-Aminophenol, PAPA); (PARACETAMOL); (TYLENOL)]] level and provide sitter with medical detainment until formal psychiatric evaluation_. Accucheck, Chem 7, and CBC to evaluate for possible metabolic perturbances_. Seizure precautions for possible [[AWS (Alcohol Withdrawal Syndrome)]] and monitor for respiratory and mental status for _ overdose. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Finally, will contact poison control; continue fluid rehydration, trend CK given period of immobilization_. Reassess.
MDMAnticholingericIngestion
with [[AMS (Altered Mental Status)]] and ingestion of multiple medications as above_. Patient appearing dry (dry MM, anhidrotic), tachycardic (sinus on EKG with largely normal intervals), flushed peripherally with [[←←← Pupil →→→]] and delirium with high suspicion for [[Anti-Cholinergic]] component, potentially from _. Given [[Hyperthermia]], likely secondary to anhydrotic hyperthermia and less likely [[Cerebritis; Encephalitis]] or [[CNS (Central Nervous System) Infection]] given exam and history, will start with evaporative cooling measures. Given [[Myoclonus]] and agitation, will give [[Benzodiazepine]], which will also aid to prevent [[Seizure]] secondary to possible [[Na+ (Sodium; 135-145 mEq/L)]] channel blockade (no [[ECG; EKG (Electrocardiogram; Elektro-Kardiographie)]] evidence thus far) or [[AWS (Alcohol Withdrawal Syndrome)]]. Will place foley given AMS and possible [[Urinary Retention]]. Given AMS and unclear history, will obtain CT brain and C-spine to evaluate for ICH_. Given limited exam, will obtain XR chest to evaluate for concretions_. Given likely intentional overdose, will check [[Acetaminophen; (Acetyl-Para-Aminophenol, PAPA); (PARACETAMOL); (TYLENOL)]] level and provide sitter with medical detainment until formal psychiatric evaluation_. Accucheck, Chem 7, and CBC to evaluate for possible metabolic perturbances_. Seizure precautions for possible [[AWS (Alcohol Withdrawal Syndrome)]] and monitor for respiratory and mental status for _ overdose. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Finally, will contact poison control; continue fluid rehydration, trend CK given period of immobilization_. Reassess.
MDMAnxietyPanicAttack
presenting with increased anxiety with clear trigger now resolved. Given exam and history, low suspicion for acute cardiopulmonary process including dissection, ACS, or PE. Denies any acute ingestions and denies any other medical complaints at this time. Does not endorse any [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Engages with conversation. Mood and affect are congruent. Thoughts are linear and organized, and has no AH or HI. No acute need for psychiatric consultation and patient without SI or HI. Clinically no overt toxidrome, well appearing, low suspicion for ingestion given history and exam. Contracted for safety as well as demonstration of significant insight for finding homeless shelter and follow up. Cautious return precautions discussed w/ full understanding.
MDMApicalAbscessBlock
Patient with _ apical abscess over _lower right posterior molar presenting for [[Pain Control]]. Patient well appearing, no [[Tetanus (Tetany; Trismus; Lockjaw)]] or airway involvement. No systemic symptoms and no overt e/o deep space extension. Mutual [[Decision Making]] to perform inferior alveolar [[Nerve Block]] for temporary relief and continued control with short course of [[NSAID (Non Steroidal Anti Inflammatory Drug)]] and opiates as outpatient_. Apical abscess I+D extended and small amount of pus expressed with [[Decompression]] of lesion. Low cost dental resources given. Cautious return precautions discussed w/ full understanding.
MDM[[Asthma]]
Patient presenting with [[SOB (Shortness of Breath)]]. Given exam and history, suspect likely acute [[Asthma Exacerbation]] without_ [[Status [[Asthma]]ticus]]. These [[Constellation]] of symptoms are similar to prior flares without overt deviations from normal exacerbations. Given clinical findings and history, low suspicion for pneumonia, [[PTX (Pneumothorax)]], or acute valvular failure. Patient with minimal risk factors for [[PE (Pulmonary [[Embolism]]/ous)]] and atypical ACS. As such, will trial bronchodilators, [[Steroid]], monitor respiratory status closely, reassess.
MDMBackPain
Patient presents with several days_ of [[Lower [[Back Pain (Dolor)]]]], atraumatic, afebrile.
Given history and exam, suspect likely [[MSK (Musculoskeletal)]] etiology_.
Nontoxic appearing and no overt risk factors for [[EDH (Epidural Hematoma)]] or abscess.
No overt e/o [[CES (Cauda Equina Syndrome)]] or acute critical cord compression with nonfocal neuro exam.
Neurovascularly intact distally.
No e/o prostatitis or [[Fournier Gangrene]].
No peritoneal signs or [[Abdominal Pain]] on exam with low suspicion for AAA.
MDMBartholins
Patient with _ [[Bartholin Gland Cyst]] with concurrent [[Bartholin Gland Abscess]] formation.
No overt evidence of [[Fournier Gangrene]] or deep space involvement. No systemic symptoms.
Small medial incision made with copious drainage of pus.
Insertion of [[Word Catheter]] to maintain tract and follow up with OB/GYN discussed.
[[Wound Care]] and return precautions discussed.
MDMBetaBlockerIngestion
Given [[Beta (Adrenergic) Blocker]] overdose, will continue [[Cardiac Monitor]] although no initial evidence of [[PR Prolongation]] or any brady[[Dysrhythmia]]; also not bradycardic or [[Hypotensive]]; will check lytes for possible mild [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]] and [[↓Glucose↓]]. No acute indication at this time for [[Beta (Adrenergic) Blocker]] overdose treatment including [[Atropine (ATROPEN)]], glucagon, [[Ca (2+(+)) (Calcium)]], [[Vasopressor]], high-dose [[INS (Insulin)]] (with glucose), or lipid emulsion therapy. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Will contact poison control; continue fluid rehydration. Reassess.
MDMBetaBlockerIngestion
Given [[Beta (Adrenergic) Blocker]] overdose, will continue [[Cardiac Monitor]] although no initial evidence of [[PR Prolongation]] or any brady[[Dysrhythmia]]; also not bradycardic or [[Hypotensive]]; will check lytes for possible mild [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]] and [[↓Glucose↓]]. No acute indication at this time for [[Beta (Adrenergic) Blocker]] overdose treatment including [[Atropine (ATROPEN)]], glucagon, [[Ca (2+(+)) (Calcium)]], [[Vasopressor]], high-dose [[INS (Insulin)]] (with glucose), or lipid emulsion therapy. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Will contact poison control; continue fluid rehydration. Reassess.
MDMBetaBlockerIngestion
Given [[Beta (Adrenergic) Blocker]] overdose, will continue cardiac monitor although no initial evidence of [[PR Prolongation]] or any brady[[Dysrhythmia]]; also not bradycardic or [[Hypotensive]]; will check lytes for possible mild [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]] and [[↓Glucose↓]]. No acute indication at this time for [[Beta (Adrenergic) Blocker]] overdose treatment including [[Atropine (ATROPEN)]], glucagon, [[Ca (2+(+)) (Calcium)]], [[Vasopressor]], high-dose [[INS (Insulin)]] (with glucose), or lipid emulsion therapy. Given temporal nature of ingestion and AMS, no acute indication for whole bowel irrigation or [[Charcoal]]. Will contact poison control; continue fluid rehydration. Reassess.
MDMBlackWidow
Patient with possible latrodectus envenomation to dominant hand_ several hours prior. Now with [[Constellation]] of symptoms, potentially consistent with mild envenomation including diffuse pain in extremity. Hand with possible area of early cellulitis but no frank abscess formation. Will treat with doxy given allergy profile after conversation with pharmacist. Area of inoculation without local [[Sweating]]. No overt evidence of necrosis or abscess. No cardiothoracic symptoms, no peritoneal signs. At this time, will trial [[Pain Control]] and muscle relaxants. Will continue to monitor and will hold antivenom at this time. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] up to date.
MDM[[CHF (Congestive v[[HF (Heart Failure)]])]]
with worsening [[SOB (Shortness of Breath)]] over the past few weeks with [[Constellation]] of symptoms concerning for possible [[CHF (Congestive v[[HF (Heart Failure)]])]] exacerbation. Patient not overtly hypoxic with minimal [[Respiratory Distress]]. No overt evidence of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] on EKG. Will trial [[Nitroglycerin(e)]] for afterload reduction, [[Diuresis]] with strict I/O presuming no evidence of AKI or cardiorenal syndrome_. Trend troponin although low suspicion for [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] given history and exam_. Low suspicion for acute PE given exam and history. Given decline in functional status, consider admission for [[Diuresis]] and further cardiac evaluation_.
MDMChestPainLowRisk
with history of tobacco abuse, otherwise healthy, p/w atypical chest pain, subacute worsening of [[Chronic Pain]]. No overt risk factors for ACS and serial EKGs and troponins without overt e/o [[NSTEMI (Non ST (Segment) Elevation [[MI (Myocardial Infarction)]])]]. Pain reproducible on exam with likely [[MSK (Musculoskeletal)]] component. Low Wells score with low risk for PE and no significant hypoxia_. Given chronicity, low s/f dissection. [[Pain Control]]led, well appearing. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
MDMChestPainNoTrop
p/w atypical chest pain, subacute onset of atypical chest pain. No overt risk factors for ACS aside from HLD_ and EKG w/o overt e/o [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]]. Pain reproducible on exam with likely [[MSK (Musculoskeletal)]] component. Low Wells score and PERC negative with low risk for PE and no significant hypoxia. Given duration, low s/f dissection. [[Pain Control]]led, well appearing. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
MDMChestPainObs
Patient presents with chest pain without signs of [[Acute [[Ischemia (Inadequate Delivery Of Oxygenated Blood)]]]] on ECG. Patient given aspirin and is currently chest pain free. Low Wells score with low risk for PE and no significant hypoxia_. Given exam and history, low suspicion for dissection. No ectopy noted on monitor and patient well appearing. Had conversation with pt at length regarding risks vs benefits of admission to obs for chest pain. Mutual [[Decision Making]] for patient to be admitted to obs, and agrees to workup. Low suspicion for overt ACS but given age and persistence of symptoms, plan to admit to obs for [[Serial Troponin]], serial EKGs, and risk stratification as inpatient.
MDM[[Clavicular]]Fracture
Patient with L_ minimally displaced [[Clavicular]] fracture after falling onto L side. Distally neurovascularly intact in extremities. No overt evidence of significant head trauma. Mentating well with non-focal neurologic exam. Placed in sling and [[Adhesive Capsulitis (Frozen Shoulder Syndrome)]] precautions discussed. Follow up with pediatric orthopedics. Return precautions.
MDMConcussion
presenting s/p minor head trauma with headache, lightheadedness, and nausea_. Given mechanism and nonfocal neurologic exam, low suspicion at this time for ICH or significant C-spine injury. Concussion care and precautions discussed. After extensive discussion with patient and family_ regarding observation versus CT and risks and benefits of both, mutual decision making to observe and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or [[Basilar Skull Fracture]]. Patient with nonfocal neurologic exam and with low suspicion for overt ICH. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.
MDMCornealAbrasion
presenting with 1 day of left [[Eye Pain]]_ after irritation yesterday. Patient is a contact lens-wearer. Visual acuity otherwise preserved. Given exam and history, no overt evidence of scleritis, purulent conversion, or [[Cornea(l) Ulcer(ation)(s)]]. Patient does however have small corneal abrasion, which will be treated with antibiotic eyedrops_. Patient to avoid wearing contacts in interim and prompt follow up with ophthalmology discussed.
MDMDentalFractures
Patient without overt maloccusion and given mechanism and history, low suspicion at this time for significant mandibular or maxillary fracture and will defer imaging at this time. Prompt follow up with plastics arranged and discussed. In regards to fractured dentition, likely Ellis II_, patient with access to [[Dentist]] in 24 hours and after R/B/A discussed, patient deferred antibiotics and cementing of tooth which is reasonable given degree of fracture and prompt follow up. Strict return precautions discussed.
MDMDiplopiaBenign
with isolated episode of binocular_ diplopia now resolved with nonfocal neuro exam with low suspicion for TIA.
Patient with minimal neurovascular/CVA risk factors and with prompt follow up with neurology already arranged.
Low suspicion given exam and history for CNS or facial infection including meningitis or [[CST (Cavernous Sinus Thrombosis)]] (no facial tenderness, ptosis and no limitation of [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]], IV, V, VI) , aneursym (no e/o [[CN3 (Cranial Nerve III) Palsy]], headache, no personal or family history).
No e/o Horner’s syndrome or inflammatory process (i.e. GBS/MF, myasthenia, or temporal arteritis).
Exam and history with no overt e/o monocular diplopia with low suspicion for acute media or refractive pathology, [[Optic Neuritis]], or uveitis.
MDMElbowSprain
with elbow pain after fall. X-ray does not reveal any overt fractures. Discussed discharge instructions with patient and return precautions. Given sling for comfort and [[Adhesive Capsulitis (Frozen Shoulder Syndrome)]] precautions discussed. No overt e/o [[Compartment Syndrome]] or [[Supracondylar Fracture]]. Distally NVI per routine. Patient is well-appearing, in no apparent distress, and vital signs stable for discharge home. Return precautions for occult fracture and return for repeat imaging if needed discussed.
MDMFallMild
Patient with ground level fall _ without frank head trauma and non-focal neurologic exam. Patient with multiple abrasions but no lacerations requiring repair_. Affected areas inspected, irrigated and dressings applied. [[Wound Care]] discussed. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] up to date. Patient initially with mild headache_, single episode of emesis_ without frank abdominal injury and [[Shoulder Pain]], now resolved_. Given nonfocal exam and currently well appearing, query possible mild concussive symptoms_. As above, given mechanism and nonfocal neurologic exam, low suspicion at this time for ICH or significant C-spine injury. Concussion care and precautions discussed. After extensive discussion with patient and companion regarding observation versus CT and risks and benefits of both, mutual [[Decision Making]] to observe and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of [[AMS (Altered Mental Status)]] or basilar [[Skull Fracture]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Friend agreeing to bring patient back if any concern including if patient with recurrent vomiting or altered behavior.
MDM[[GERD (Gastroesophageal Reflux Disease)]]
Patient presents with epigastric_ [[Abdominal Pain]] most likely secondary to [[Dyspepsia (Indigestion)]] or non-acute abdominal etiology.
No peritoneal signs on abdominal exam.
Patient’s symptoms near resolved with GI cocktail.
Patient remains PO tolerant.
Serial abdominal exam without increase in [[Abdominal Pain]].
Given exam and history, low suspicion for acute abdominal process,
such as
[[Acute Cholecystitis]],
[[Pancreatitis]],
perforated viscus,
atypical [[Appendicitis]]
torsion.
Extensive conversation about return precautions and need for follow-up.
MDM[[Gallstone (Cholelithiasis)]]
Patient presents with [[Abdominal Pain]] and [[US(G) (Ultra(sound; -sonogram; sonography))]] demonstrates visible [[Gallstone (Cholelithiasis)]].
Given exam and history, suspect likely uncomplicated_ [[Biliary Colic]].
Patient is afebrile without overt thickening of the [[Gallbladder]] wall, CBD dilation or [[Pericholecystic Fluid]] suggests the absence of [[Acute Cholecystitis]] or acute biliary obstruction.
Patient is tolerating PO_ and suspicion for acute pancreatic involvement is low.
After serial abdominal exams, history and observation, low suspicion at this time for other acute intraabdominal processes, including [[AA (Aortic Aneurysm)]], atypical [[Appendicitis]], [[Diverticulitis]], or bowel obstruction.
Given resolution of pain and no peritoneal signs on serial exams, will discharge patient home with general surgery follow up and strict return precautions.
MDM[[Gastroenteritis]]
presenting with 3 days_ of vomiting and [[Diarrhea]].
Currently [[(Iso;Eu)volemia]] without any abdominal tenderness or peritoneal signs.
Nontoxic appearing; query possible [[Gastroenteritis]].
Patient also with URI symptoms and a cough over past several days – suspect viral etiology and will low suspicion for pneumonia at this time_.
Nausea control, rehydrate, serial abdominal exam, reassess.
At this time, given initial history and exam, low suspicion for torsion, PID, atypical [[Appendicitis]] or [[Cholecystitis]].
MDMHIVExposure
otherwise healthy with moderate risk HIV exposure (unprotected vaginal sex with HIV+ patient albeit with unclear last CD4 + VL)_. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]]/C, RPR, G/C and HIV and relative rates given source patient and mechanism. Patient declining vaginal exam to evaluate for tears at this time after risks discussed with full understanding and capacity. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given risk of transmission, mutual [[Decision Making]] to use PEP at this time. Discussed prompt follow up with clinic for bloodwork and serial serologies. Discussed at length regarding consensual nature of sex and patient does not feel that encounter was not consensual. Discussed that if patient changes mind, given STI treatment center resources. Patient contracts to safety and feels safe at home.
Given history, per CDC (2013) and NYSDOH (2014), patient not pregnant and will treat with Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Either Raltegravir 400 mg PO twice daily. Discussed post exposure testing at baseline6 weeks post-exposure, 12 weeks post-exposure. 6 months post-exposure at clinic. Will provide 5 days of PEP_ but discussed prompt need for follow up and full course being at least 4 weeks. Cautious return precautions discussed w/ full understanding.
MDMHeadLac
not on [[Anti-Coagulation]]_ with resultant laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] updated. NVI distally. Relatively clean wound, irrigated copiously and repaired in simple fashion with dermabond. No antibiotics indicated at this time. Given mechanism and nonfocal neurologic exam, low suspicion for ICH or significant c-spine injury. Discussed strict return precautions and [[Wound Care]].
MDMHydroflouricAcid
who presents with right hand paraesthesias s/p possible exposure to HF 14 hours ago. Given duration of symptoms and history of exposure, likely low risk dermal exposure.
In brief, [[HF (Hydrofluoric Acid)]] is usually found as a rust remover, used in glass etching or in the manufacture of silicon chips.
While there is a higher risk of co-exposure with other acids in the workplace, this was likely not the case in regards to our patient.
HF is both a dermal and respiratory irritant, however in our case, as patient was using a hood and given the questionable exposure, there is a low suspicion for cardiopulmonary symptoms at this time. As such, our patient currently does not demonstrate any overt inhalational symptoms including chemical pneumonitis or [[NCPE (Non CPE (Cardiogenic PE (Pulmonary Edema)))]]. While the concentration of HF exposure is unknown, if an exposure were to have happened, it is likely a weak or intermediate concentration as there currently is no overt signs of dermal injury. However, in weaker concentrations, there may be a delay of symptoms owning to the penetration of deeper tissues by the cytotoxic fluoride ions. As above, despite the low risk nature of exposure and relatively benign exam, after further discussion with poison control, we will obtain labs to evaluate for systemic [[↓↓↓ Calcium (Ca2+) ↓↓↓ (Hypocalcemia)]], [[↓↓↓ [[Mg2+ (Magnesium)]] ↓↓↓]] and [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]]. In the interim, the potential affected area will be irrigated extensively and if labs are unremarkable, given the time frame and history, will likely recommend continuation of topical [[Calcium Gluconate]] gel using a rubber glove to enhance skin penetration. At this time, given the [[Constellation]] of symptoms, duration, non-progressive nature and unclear history of exposure, there is no acute indication for [[SubQ (Subcutaneous)]] or systemic [[Ca (2+(+)) (Calcium)]] administration.
MDM
[[HF (Hydrofluoric Acid)]]
who presents with right hand paraesthesias s/p possible exposure to HF 14 hours ago. Given duration of symptoms and history of exposure, likely low risk dermal exposure. In brief, [[HF (Hydrofluoric Acid)]] is usually found as a rust remover, used in glass etching or in the manufacture of silicon chips. While there is a higher risk of co-exposure with other acids in the workplace, this was likely not the case in regards to our patient. HF is both a dermal and respiratory irritant, however in our case, as patient was using a hood and given the questionable exposure, there is a low suspicion for cardiopulmonary symptoms at this time. As such, our patient currently does not demonstrate any overt inhalational symptoms including chemical pneumonitis or [[NCPE (Non CPE (Cardiogenic PE (Pulmonary Edema)))]]. While the concentration of HF exposure is unknown, if an exposure were to have happened, it is likely a weak or intermediate concentration as there currently is no overt signs of dermal injury. However, in weaker concentrations, there may be a delay of symptoms owning to the penetration of deeper tissues by the cytotoxic fluoride ions. As above, despite the low risk nature of exposure and relatively benign exam, after further discussion with poison control, we will obtain labs to evaluate for systemic [[↓↓↓ Calcium (Ca2+) ↓↓↓ (Hypocalcemia)]], [[↓↓↓ [[Mg2+ (Magnesium)]] ↓↓↓]] and [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]]. In the interim, the potential affected area will be irrigated extensively and if labs are unremarkable, given the time frame and history, will likely recommend continuation of topical [[Calcium Gluconate]] gel using a rubber glove to enhance skin penetration. At this time, given the [[Constellation]] of symptoms, duration, non-progressive nature and unclear history of exposure, there is no acute indication for [[SubQ (Subcutaneous)]] or systemic [[Ca (2+(+)) (Calcium)]] administration.
MDM
[[HF (Hydrofluoric Acid)]]
who presents with right hand paraesthesias s/p possible exposure to HF 14 hours ago.
Given duration of symptoms and history of exposure, likely low risk dermal exposure.
In brief, [[HF (Hydrofluoric Acid)]] is usually found as a rust remover, used in glass etching or in the manufacture of silicon chips.
While there is a higher risk of co-exposure with other acids in the workplace, this was likely not the case in regards to our patient.
HF is both a dermal and respiratory irritant, however in our case, as patient was using a hood and given the questionable exposure, there is a low suspicion for cardiopulmonary symptoms at this time.
As such, our patient currently does not demonstrate any overt inhalational symptoms including chemical pneumonitis or [[NCPE (Non CPE (Cardiogenic PE (Pulmonary Edema)))]]. While the concentration of HF exposure is unknown, if an exposure were to have happened, it is likely a weak or intermediate concentration as there currently is no overt signs of dermal injury.
However, in weaker concentrations, there may be a delay of symptoms owning to the penetration of deeper tissues by the cytotoxic fluoride ions.
As above, despite the low risk nature of exposure and relatively benign exam, after further discussion with poison control, we will obtain labs to evaluate for systemic [[↓↓↓ [[Ca (2+(+)) (Calcium)]] ↓↓↓ (Hypocalcemia)]], [[↓↓↓ [[Mg2+ (Magnesium)]] ↓↓↓]] and [[↑ K+ (Hyperkalemia; (Elevate(s;d); Increas(e(s)); Raise(s;d)) Potassium; >5)]].
In the interim, the potential affected area will be irrigated extensively and if labs are unremarkable, given the time frame and history, will likely recommend continuation of topical [[Calcium Gluconate]] gel using a rubber glove to enhance skin penetration.
At this time, given the [[Constellation]] of symptoms, duration, non-progressive nature and unclear history of exposure, there is no acute indication for [[SubQ (Subcutaneous)]] or systemic [[Ca (2+(+)) (Calcium)]] administration.
MDMKneePain
subacute worsening of chronic [[Right Knee Pain]].
Atraumatic. Neurovascularly intact distally.
Given [[Focal Tenderness]], query possible MCL strain vs [[Bursitis]].
No systemic symptoms and nontoxic; given exam and history, low suspicion for [[Septic Arthritis]], pyomyositis or [[NF (Necrotizing Fasciitis)]].
No e/o [[Compartment Syndrome]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]].
MDMKneePainTrauma
with R_ knee pain and mild swelling after injury. Neurovascularly intact distally. Given [[Focal Tenderness]], query possible ligamentous injury however no gross instability. No tibial plateau tenderness. XR without frank fracture. Low suspicion for [[Vascular Injury]] with dislocation-relocation. No ankle or [[Hip Pain]]. No [[Back Pain (Dolor)]] with low supicion for significant axial load. No systemic symptoms and nontoxic; given exam and history, low suspicion for [[Septic Arthritis]], pyomyositis or necrotizing fascitis. No e/o [[Compartment Syndrome]] or [[DVT (Deep (Vein; Venous) (Thrombosis; Thromboembolism))]]. [[Pain Control]]. Follow up with PMD and ortho as needed. Cautious return precautions discussed w/ full understanding.
MDMLacChin
with chin injury and superficial arm abrasions s/p fall from scooter_ prior to arrival. Pt with resultant chin laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] UTD. No maloccusion with low suspicion for mandibular fracture. No LOC and low suspicion for ICH. Relatively clean wound, irrigated copiously and repaired in simple fashion with sutures. No antibiotics indicated at this time. Discussed strict return precautions, follow up for suture removal and [[Wound Care]]. Extremity exam with full range of motion, no [[Bony Tenderness]] and distally neurovascularly intact.
MDMLacGen
with resultant laceration requiring simple repair. [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] updated. XR w/o overt e/o fracture. NVI distally. Relatively clean wound, irrigated copiously and repaired in simple fashion with staples_. No antibiotics indicated at this time. NVI per routine post repair. No overt e/o [[Compartment Syndrome]]. Discussed strict return precautions, follow up for staple removal and [[Wound Care]].
MDMLacRepair
Wound inspected under direct bright light with good visualization.
Area with linear laceration across soft tissue through adipose without exposure of muscle belly or tendon_.
No overt [[Foreign Body]].
Area hemostatic.
Neurovascular exam congruent with above.
Area extensively irrigated with sterile [[0.9% NS; NaCl (Normal Saline; [[Na+ (Sodium; 135-145 mEq/L)]] Cl- (Chloride (95-105))]] under pressure.
Laceration repaired in simple fashion as below (please see procedure note for further details)_.
Patient tolerated procedure well and neurovascular exam intact and unchanged post repair with intact distal pulses and cap refill_.
Cautious return precautions discussed w/ full understanding.
[[Wound Care]] discussed.
Prompt follow up with primary care physician discussed and return for suture removal.
MDMMVALowSpeed
otherwise healthy involved in restrained MVA with airbag deployment. Patient with pain predominantly to L paraspinal and L [[Clavicular]] area_. [[Hemodynamic]]ally appropriate with nonfocal neurologic exam. Given exam and history, low suspicion for traumatic dissection or ICH. CT c-spine without overt fracture or dislocation with low suspicion for ligamentous injury on re-examination. Serial abdominal exam without tenderness and FAST initially unremarkable. Observed for several hours in ED with clinical improvement. Stable gait and tolerating PO. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
MDM[[Migraine (Headache)]]
with history of chronic intermittent [[Migraine (Headache)]], recently started on triptan_, now presenting with similar [[Constellation]] of symptoms without overt evidence and low suspicion for [[ICH (Intracranial Hemorrhage)]], [[SAH (Subarachnoid Hemorrhage)]], or CNS affection. Patient with non-focal neuro exam. Patient not immunocompromised and no family history of bleeding dyscrasias or aneursymal rupture. Headache slow onset and similar to prior exacerbations. Will attempt [[Pain Control]], serial neuro exams, and reassess.
MDMNeckPainTrauma
with no pertinent history presents with now resolving R_ paraspinal neck pain. No acute findings on exam; in particular, no midline spinal tenderness to palpation. Non-focal neuro exam with sensation and strength intact and equal bilaterally. Low suspicion for cervical ligamentous or [[Vascular Injury]]. Intact grips and UE exam with low suspicion for central cord. Discussed [[Pain Control]], observation of symptoms. Cautious return precautions discussed w/ full understanding.
MDMNeckSwelling
Patient otherwise healthy_, fully vaccinated_ with anterior neck swelling likely secondary to significant lymphadenopathy of limited duration with suspicion for likely viral etiology. BUS with visualization of LAD without frank abscess. Mild [[Tetanus (Tetany; Trismus; Lockjaw)]] on exam but no overt e/o PTA or RPA. No overt e/o deep space infection; nontoxic appearing and tolerating PO. Non-focal neuro exam with low suspicion for [[Lemierre Syndrome]]. Vaccinated with low suspicion for mumps. Low suspicion for malignancy or goiter formation at this time given duration but discussed prompt follow up to reassess. Trial antibiotics_ and [[Steroid]]_ with cautious return precautions discussed w/ full understanding. Airway fully patent.
MDMPECARNAbdominalTrauma
Patient denies severe mechanism of injury. Patient does not have overt evidence of abdominal wall trauma or [[Seat Belt]] sign. Patient is currently alert and at baseline mental status and activity level per family. Patient denies any abdominal tenderness and does not have evidence of thoracic wall trauma. Breath sounds remain equal bilaterally. Denies nausea or vomiting.
MDMPECARNHead
Patient is currently at baseline mental status and activity level per family. Patient does not have evidence of palpable skull fractures or step offs. Patient does not have an occipital, parietal or temporal hematoma. Denies LOC > 5 seconds. No signs of basilar skull injury including [[Raccoon eyes]], [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], CSF rhinorrhea or hemotympanum. No nasal hematoma. Denies vomiting or headache. Denies severe mechanism of injury.
MDMPEDS[[Appendicitis]]NoScan
Patient with [[Abdominal Pain]] and vomiting, now resolved_. No peritoneal signs with low suspicion for acute intraabdominal process including torsion, SBO, [[Intussusception]] or atypical [[Appendicitis]]. Serial abdominal exams throughout course without increase in pain or migration of pain. Tolerating PO in ED. US appendix inconclusive_. After extensive discussion with family regarding observation versus CT versus return for recheck in 8-12 hours if not resolved and risks and benefits of options, mutual [[Decision Making]] to return for recheck given relative improvement and well appearing child with alternative diagnoses (_) for fever and [[Malaise]] and not pursue further workup at this time. Patient tolerating PO, continue to be at baseline and well appearing. As above, does not have signs of peritoneal involvement. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with recurrent vomiting, increase in [[Abdominal Pain]], or altered behavior. Will discuss prompt follow up with PMD and strict return precautions discussed.
MDMPEDSBurn
with no previous medical history presents brought in by parents for superficial scattered burns primarily to torso_ with minimal BSA involved. Burns superficial, consistent with history and given interaction observed between parents, low suspicion at this time for NAT. Parents and patient appropriate. Patient undressed fully without any suspicious lesions. Discussed [[Wound Care]], [[Pain Control]] and follow up with PMD. Return precautions for superinfection. Patient at baseline currently without significant burns over scalp, face, groin or distal extremities. Cautious return precautions discussed w/ full understanding.
MDMPEDSFussy
otherwise healthy, full term, brought in by parents for 1 day_ of increased fussiness. Afebrile, full term, currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing [[(Iso;Eu)volemia]] with appropriate linear [[Weight Gain]] since birth. No meningismus, otherwise at baseline activity level with low suspicion for [[CNS (Central Nervous System) Infection]]. Patient wearing mittens_, no excessive tearing or redness, and without long nails with low suspicion for [[Corneal Abrasion]]. No overt evidence of NAT or hair tourniquets. No malignant rashes noted and improving [[Diaper Rash]] per parents on exam. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of [[CNS (Central Nervous System) Infection]] including but not limited to changes in mental status or vomiting, or fever. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.
MDMPEDSRash
fully immunized, otherwise healthy, p/w isolated rash likely due to viral exantham_ given history, temporal nature and appearance. No mucous membrane involvement with low suspicion for SJS/TEN. No [[Wheez(-e -es; -ing)]] or difficulty breathing with low suspicion for systemic involvement. Low suspicion for scabies given history and exam. Discussed close monitoring for progression. Cautious return precautions discussed w/ full understanding. No overt e/o superinfection. Prompt follow up with primary care physician discussed.
MDMPEDSURI
with vaccinations up to date_, full term, otherwise healthy boy presenting with fever and [[Constellation]] of upper respiratory symptoms. Currently well appearing, nontoxic. Given history and exam, low suspicion for serious bacterial infection including meningitis, pneumonia, UTI or bacteremia. Tolerating PO and appearing [[(Iso;Eu)volemia]]. Mild fever and well appearing after [[Ibuprofen; ((ADVIL), (MOTRIN))]] administration. No meningismus, otherwise at baseline activity level with low suspicion for [[CNS (Central Nervous System) Infection]]. Query likely viral etiology. Discussed low risk but possible UTI and offered catherterized urine sampling, but mutual [[Decision Making]] at this time to defer after discussion with parents_. Discussed alternating tylenol and [[Ibuprofen; ((ADVIL), (MOTRIN))]] as directed over the counter for antipyresis. Discussed strict return precautions for worsening of symptoms, increased respiratory effort, signs of [[CNS (Central Nervous System) Infection]] including but not limited to changes in mental status or vomiting, or fever for more than 5 days. Discussed prompt follow up with primary pediatrician in 24-48 hours for recheck or return to ED sooner if concern or if cannot schedule appointment.
MDMPEDSUTI
[[Immunization]]s UTD_, otherwise healthy, not immunocompromised, presenting with fever and [[Malaise]]. [[Constellation]] of symptoms and history concerning for possible UTI_. Patient is extremely well appearing, mentating well, at baseline per parents, lucid and without meningismus. Nonfocal neuro exam with low suspicion for [[CNS (Central Nervous System) Infection]]. No [[Respiratory Distress]] with low suspicion for pneumonia. No [[Abdominal Pain]] and benign abdominal exam with low suspicion for atypical [[Appendicitis]]. No overt findings for vulvovaginitis_. UA with some WBC and + LE_. Given symptoms, will treat with [[Cephalexin (KEFLEX)]]_ for possible upper tract infection. Tolerating PO including juice and crackers in ED. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. [[Appendicitis]] return precautions discussed.
MDMPEP
After extensive discussion with patient regarding PEP versus observation/follow up and risks and benefits of both, mutual [[Decision Making]] to provide first dose of PEP and follow up promptly with outpatient testing and further treatment as needed at this time per most recent CDC HIV PEP guidelines for unknown relatively high risk exposures_. Discussed that single dose of PEP is not a substitute for follow up and further care/evaluation. Discussed need for concurrent testing of other STI including, but not limited to, G/C and RPR. Discussed safe sex practices_. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
MDMPEPOccHealth
with occupational work exposure with relatively low risk of transmission. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]], C and HIV and relative rates given source patient and mechanism. [[Immunization]]s UTD as above, specifically [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] and [[HBV (Hepatitis B (Virus))]] vaccinations. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given relatively low risk of transmission, mutual [[Decision Making]] to defer PEP at this time. Discussed prompt follow up with occupational health for bloodwork and serial serologies as needed.
MDMPEPOccHealth
with occupational work exposure with relatively low risk of transmission. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]], C and HIV and relative rates given source patient and mechanism. [[Immunization]]s UTD as above, specifically [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] and [[HBV (Hepatitis B (Virus))]] vaccinations. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given relatively low risk of transmission, mutual [[Decision Making]] to defer PEP at this time. Discussed prompt follow up with occupational health for bloodwork and serial serologies as needed.
___
NYSDOH AI Recommendations (2014)
Indication: Percutaneous or [[Mucocutaneous]] exposure with blood or visibly [[Bloody Fluid]] or other potentially infectious material.
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily or [[Lamivudine (EPIVIR)]] 300 mg PO daily plus Either Raltegravir 400 mg PO twice daily or [[Dolutegravir (DOVATO)]] 50 mg PO daily
HIV Antibody Testing of Healthcare Worker
Baseline
4 weeks post-exposure
12 weeks post-exposure
When a potential [[Occupational Exposure]] to HIV occurs, every effort should be made to initiate PEP, as soon as possible, ideally within 2 hours. A first dose of PEP should be offered to the exposed worker while the evaluation is underway. In addition, PEP should not be delayed while awaiting information about the source or results of the exposed individual’s baseline HIV test.
Decisions regarding initiation of PEP beyond 36 hours post exposure should be made on a case-by-case basis with the understanding of diminished efficacy when timing of initiation is prolonged.
CDC Recommendations (2013)
* Kuhar DT, Henderson DK, Struble KA, et al. Updated U.S. Public Health Service guidelines for the management of [[Occupational Exposure]]s to [[HIV (Human Immunodeficiency Virus)]] and recommendations for postexposure [[Prophylaxis]]. Infect Control Hosp Epidemiol 2013;34: 875-892. Available at: http://stacks.cdc.gov/view/cdc/20711
Indications: Percutaneous injury or contact of mucous membrane or nonintact skin with blood, tissue, or potentially infectious body fluids, such as semen, vaginal secretions, and visibly [[Bloody Fluid]]s and reasonable suspicion that the source patient is HIV-infected.
Source Testing:
Although concerns have been expressed regarding HIV-negative sources being in the window period for seroconversion, no case of transmission involving an exposure source during the window period has been reported in the United States. Rapid HIV testing of source patients can facilitate making timely decisions regarding use of HIV PEP after occupational exposures to sources of unknown HIV status.
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily + Raltegravir 400 mg PO twice daily
Duration of PEP: 4 weeks
HIV Antibody Testing of Healthcare Worker
Baseline
6 weeks post-exposure
12 weeks post-exposure
6 months post-exposure
Alternatively, if the clinician is certain that a fourth-generation antibody/antigen combination assay is being used, then HIV testing could be performed at baseline, 6 weeks, and concluded at 4 months post-exposure.
PEP should be initiated as soon as possible, preferably within hours rather than days of exposure. Initiation of PEP should not be delayed while awaiting the results of a source patient’s HIV test, nor should it be delayed during consultation with experts to determine ideal PEP regimens.
Rationale:
Several clinical studies have demonstrated that HIV transmission can be significantly reduced by the post-exposure administration of [[Anti-Retroviral Therapy]] agents. A dramatic decline in vertical transmission was observed in the AIDS Clinical Trial Group (ACTG) 076 study,1 in which pregnant women and their newborns received monotherapy with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] ([[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]), and in the HIVNET 012 study,2 in which single-dose [[NVP (Nevirapine, VIRAMUNE)]] was compared with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]. A CDC retrospective [[Case Control]] study3 of [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] use after occupational HIV exposure in healthcare workers (HCWs) showed an 81% reduction in risk of [[HIV (Human Immunodeficiency Virus)]] in persons who received [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]].
Because the ultimate goals of PEP are to maximally suppress any limited viral replication that may occur and to shift the biologic advantage to the host cellular immune system to prevent or abort early infection, the Committee recommends the use of a three-drug PEP regimen for all significant risk exposures.
Relative Risks:
Estimated Per-Act Probability of Acquiring HIV From a Known HIV-Infected Source by Exposure Act
Type of Exposure Risk per 10,000 Exposures
Parenteral
Blood Transfusion 9,000
Percutaneous ([[Needle Stick]]) 30
Sexual
Receptive anal intercourse 138
Insertive anal intercourse 11
Receptive penile-vaginal intercourse 8
Insertive penile-vaginal intercourse 4
Receptive oral intercourse low
Insertive oral intercourse low
Other
Biting Negligible
Spitting Negligible
Throwing body fluids Negligible
(including semen or saliva)
http://www.cdc.gov/hiv/law/transmission.htm.
Factors that increase the risk of HIV transmission include early and late-stage [[HIV (Human Immunodeficiency Virus)]] and a high level of HIV in the blood. Factors that reduce the risk of HIV transmission include low level of HIV in the blood and the use of ART.
MDMPedsChestPainIngestion
with atypical [[Chest Discomfort]] and now resolved palpitations in the setting of Adderall_ use. No overt risk factors for early cardiac disease; no family history of early cardiac death. Patient well appearing, nontoxic. Low Wells score with low s/f PE; no overt hypoxia. Given history and exam, low suspicion for ACS, dissection, or [[PTX (Pneumothorax)]]. Discussed cessation of Adderall_ and follow up with PMD for further evaluation as needed. Cautious return precautions discussed w/ full understanding.
MDM[[Pericarditis]]
with positional chest pain for the past 2 days_. Recent mild cough, [[Sore Throat (Pharyngitis)]]_. EKG obtained consistent with [[Pericarditis]]. BUS w/o overt tamponade or significant effusion. Query possible [[Recent [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]]]] as trigger. No overt e/o AKI or CKD, malignancy, HIV, TB. No overt high risk factors for complicated [[Pericarditis]] including fever, no e/o large pericardial effusion or tamponade, no immunosuppression, [[Anti-Coagulation]], or trauma. Low suspicion given history and exam for concurrent [[Myocarditis]], ACS or PE. Discussed activity restriction until symptom resolution. Discussed treatment with [[NSAID (Non Steroidal Anti Inflammatory Drug)]] ([[Ibuprofen; ((ADVIL), (MOTRIN))]] TID per ESC guidelines) with low risk for GIB (no history of PUD, age < 65, and no concurrent [[Anti-Coagulation]]) and cotreatment with [[Colchicine (MITIGARE, COLCRYS)]] given lack of risk factors for toxicity (low suspicion for CKD given age) and potential benefits (significant reduction in the risk of recurrence – ICAP trial NEJM 2013)_. Discussed need for close follow up with ASHE and cardiology referral as well as strict return precautions for worsening chest pain, signs of [[CHF (Congestive v[[HF (Heart Failure)]])]]/fluid overload/tamponade, or infection.
MDM
[[Pre-Eclampsia]]
history of [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] presents for [[HTN; HBP (Hypertension; High Blood Pressure; ≥ 140\90 mmHg)]] with SBP _ sent in by PMD with concern for possible [[Pre-Eclampsia]].
Of note, patient without severe range BP in ED.
Patient without neuro or ocular concerns at this time.
No RUQ and no frank proteinuria.
No seizure activity and without cardiothoracic symptoms..
Benign abdominal exam and non-focal neuro exam.
Labs largely reassuring_.
Therefore, given history and exam, low suspicion at this time for [[Fulminant]] [[Pre-Eclampsia]] requiring admission.
No overt evidence of HELLP, acute [[Cholestasis]] of pregnancy, or eclampsia at this time.
Discussed case with OB and after evaluation, will _.
Cautious return precautions discussed w/ full understanding.
Prompt follow up with primary care physician/OB arranged and discussed_.
MDMPsych
Denies any ingestions and denies any other medical complaints. Does not endorse any [[AWS (Alcohol Withdrawal Syndrome)]] symptoms. Engages with conversation. Mood and affect are congruent. Thoughts are linear and organized, and has no AH or HI. Plan admit to psychiatry for further management of symptoms. Will consult psychiatry to evaluate Patient for potential hold for danger to self. Clinically no overt toxidrome, well appearing, low suspicion for ingestion given history and exam.
MDMRabies
_ with bat exposure who presents for [[IgA (Ig (Immunoglobulin) A)]]dministration. Patient without obvious wound but given duration of exposure, high risk nature and possible [[Incubation Period]] (of up to 1-3 months), mutual [[Decision Making]] with patient re: R/B/A to give dose of RiG. Per most recent CDC/ACIP guidelines re: PEP for human rabies, patient with 1st of 4-dose rabies vaccination regimen prior to arrival (0, 3, 7, 14; HDCV or PCECV). Discussed need for subsequent doses. Patient without altered immune competence. No obvious inoculation wound, as such, will infiltrate weight based RIG IM_. Patient currently largely asymptomatic with non-focal exam with no symptoms of cerebral dysfunction, anxiety, confusion, agitation, delirium, abnormal behavior, [[Hallucinations]], and [[Insomnia (Nighttime Wakefulness)]]. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
MDMRenalColic
Patient presents with flank pain consistent with previous [[Nephrolithiasis ((Kidney; Renal) Stone(s))]] pain. Patient otherwise well-appearing with low suspicion for sepsis, dissection or infected obstructed [[Renal Colic]]. US w/ mild [[Hydronephrosis; Ureterectasis (Hydro;Ureter(o));(nephrosis;ectasis))]] on affected side_. Low suspicion for atypical [[Appendicitis]], torsion, acute chole, or intraabdominal infection. Discussed conservative management, strict return precautions and follow up with urology. Will discharge with [[FLOMAX (Tamsulosin)]]_, [[NSAID (Non Steroidal Anti Inflammatory Drug)]], opiates for breakthrough, strainer, and antiemetics. Patient tolerating PO and [[Pain Control]]led prior to discharge. Strict return precautions for infected stone or PO intolerance discussed. Low suspicion for AKI, obstructive nephropathy given exam and history.
MDMRetinalDetachment
Patient presenting with [[Constellation]] of symptoms concerning for vitreous [[Hemorrhage]] vs [[Retinal Detachment]]. Not contact lens wearer_. No prior ocular history_. Patient is headache free and visual acuity intact with low suspicion for [[GCA; TA ((Giant Cell; Temporal) Arteritis)]] or [[CRAO (Central RAO (Retinal Artery Occlusion))]]/CRVO. No vision changes or [[Conjunctival Injection]] with low suspicion for [[Acute Angle Closure]] glaucoma. No trauma to the eye and no sensation of [[Foreign Body]] with low suspicion for [[Cornea(l) Ulcer(ation)(s)]] or globe injury. No evidence of overt [[Hyphema]] or [[Hypopyon(s)]] on exam. No ocular pain or consensual [[Photophobia]] with low suspicion for scleritis or iritis. Plan to discuss case with ophthalmology for dilated exam and further assessment.
MDMScabies
subacute rash over months_. Given distribution, characteristics and associated symptoms, likely secondary to scabies vs bedbugs. No overt mucosal involvement w/ low s/f TEN/SJS/EM. No e/o superinfection. Discussed hygiene/de[[Contamination]] measures, continue ivermectin and [[Permethrin]]_; symptomatic t/w [[Diphenhydramine (BENADRYL®)]] and steroid burst. F/u w/ dermatology as discussed. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed.
MDMSepsisGen
who presents with fever and ¾_ [[Systemic Inflammatory Response Syndrome (SIRS) Criteria]]. Resuscitation via EGDT with 30 cc/kg NS bolus with stabilization in vitals. Empiric [[Antibiotic Therapy]], albeit with modified regimen given suspected intraabdominal source_ and allergy profile_. CXR, cultures, and UA. Consider [[NE (NoreEpi, Norepinephrine, Noradrenaline LEVOPHED)]] if patient not fluid responsive. Monitor [[Hemodynamic]] status. Admit to medicine for further care.
MDMSepsisImmunosuppressedWell
s/p [[Renal Transplant]]_ and s/p OHT_ who presents with fever for past several days and intermittent [[Productive Cough]]_. Despite patient being well appearing, will perform septic workup with concern for possible CAP. Will obtain CXR, labs, blood cultures, urine cultures, UA. Will also get troponin (to evaluate for [[Myocarditis]]), BNP (to trend for possible rejection). No overt evidence of fluid overload at this time. No overt hospital acquired risk factors but given immunosuppression and concern for pulmonary cause, will empirically treat with vanc/[[Cefepime (MAXIPIME, VOCO)]]/[[Azithromycin (ZITHROMAX, Z-PACK)]]_ and will defer to medicine team to narrow. Although grafts working well on prior visit, as patient not overtly septic, will gently hydrate with NS given [[Hemodynamic]] stability and propensity for possible graft dysfunction/fluid overload_.
MDMSepticArthritis
Given exam and history, low suspicion for septic arthritis at this time given location of pain (not over knee joint but superior to area), subacute nature, and relative comfort to range of motion and axial loading. Nontoxic appearing and no overt systemic symptoms. Atraumatic with low suspicion for fracture or dislocation. No overt e/o [[NF (Necrotizing Fasciitis)]]. Given tenderness and area of erythema, will treat for cellulitis. Neurovascularly intact per routine as above with no overt e/o compartment syndrome.
After extensive discussion with patient and wife regarding observation and treatment of possible cellulitis versus [[Arthrocentesis]] and risks (overlying cellulitis, lower [[Pre-Test]] probability of [[Septic Arthritis]], risk of inoculation of joint) and benefits of both, mutual [[Decision Making]] to trial antibiotics and not pursue further [[Arthrocentesis]] at this time. Patient tolerating discomfort, continue to be at baseline and well appearing. As above, does not have signs of systemic symptoms or neurovascular compromise. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed. Family agreeing to bring patient back if any concern including if patient with increase in pain, inability to range or bear weight, or fevers.
MDM
[[Sickle Cell]] VOC
with history of SSD Hb SS_,
functionally asplenic_,
[[Immunization]]s for encapsulated organisms reportedly up to date,
complicated prior by_ [[Avascular Necrosis]] of humerus and femur,
and [[Acute Chest Syndrome]] syndrome_,
last transfusion several months prior_,
baseline hgb _ now
presenting with [[Constellation]] of symptoms similar to prior
acute vasooclusive
pain crises without overt trigger. Patient is afebrile, not hypoxic and without
[[Dyspnea]] with low suspicion at this time for [[Acute Chest Syndrome]]. Will trend [[Hb (Hemoglobin)]] and [[Reticulocyte Count]] to evaluate for possible hemolytic vs aplastic crisis, although low suspicion at this time. No overt worsening of [[Avascular Necrosis]] or [[Osteomyelitis]] on exam. Nonfocal neuro exam with low suspicion at this time for end [[Organ Dysfunction]] from VOC including CVA, ACS, AKI or hepatobiliary complications. Will continue to monitor, [[Pain Control]], gentle hydration, and follow up labs.
MDMStrepThroat
with otherwise healthy, fully vaccinated with [[Sore Throat (Pharyngitis)]] likely secondary to viral URI vs [[[[Strep(tococc(us;I;al))]] Pharyngitis]]. No [[Tetanus (Tetany; Trismus; Lockjaw)]] on exam and no overt e/o PTA or RPA. No overt e/o deep space infection; nontoxic appearing and tolerating PO. Centor _. Non-focal neuro exam with low suspicion for [[Lemierre Syndrome]]. Trial antibiotics and [[Steroid]] with cautious return precautions discussed w/ full understanding. Tolerating PO and otherwise well appearing.
MDMStye
with stye vs chalazion to right upper eyelid. Patient well appearing without overt evidence of septal or pre-septal cellulitis. No overt evidence of [[CST (Cavernous Sinus Thrombosis)]]. Will discharge with recommended warm compresses at home and optho follow-up this week. Low suspicion for [[Foreign Body]] or [[Corneal Abrasion]] given history and exam.
MDMSyncopeFall
Patient presents after ground level fall, currently in c-spine precautions with likely LOC_. Unwitnessed fall, with unclear etiology, possible mechanical but cannot r/o syncope at this time. Patient without any [[Prodrome]] symptoms with low suspicion at this time for ACS, dissection or malignant [[Arrhythmia (Abnormal Rhythm)]]. Will check labs for electrolyte protuberances, will obtain CT brain and C-spine to evaluate for ICH as patient is [[Anti-Coagulation]]d_. Given history, low suspicion for ACS, but will obtain troponin and EKG for cardiac evaluation and reassess_. Currently at baseline mental status. No [[Respiratory Distress]] or hypoxia with low suspicion for massive PE at this time. Serial neurologic exams and monitor in interim.
MDMSyncopeVasoVagal
who presents with syncope prior to arrival. Witnessed syncope, likely vasovagal in etiology given history and exam. Patient currently at baseline mental status. No chest pain with low s/f dissection or ACS. No hypoxia or tachypnea with no risk factors for PE. No overt e/o malignant [[Arrhythmia (Abnormal Rhythm)]] on serial EKG. Patient not pregnant_. PO challenge. Cautious return precautions discussed w/ full understanding. Prompt follow up with primary care physician discussed for further workup as needed.
MDMURI
otherwise healthy presenting with [[Constellation]] of symptoms likely representing uncomplicated viral upper respiratory symptoms as characterized by mild [[Sore Throat (Pharyngitis)]] without overt evidence of RPA/PTA, deep space infection/[[Ludwig Angina (Dental Sepsis)]]’s, or bacterial superinfection_. Low suspicion for CNS infection bacterial sinuitis, or pneumonia given exam and history. Will attempt to alleviate symptoms conservatively; no overt indications at this time for antibiotics. No [[Respiratory Distress]], otherwise relatively well appearing and nontoxic. No peritoneal signs with low suspicion for acute intraabdominal process. Will discuss prompt follow up with PMD and strict return precautions discussed.
MDMUTIMale
with with no significant medical history who presents with UTI without overt e/o infected stone or prostatitis. BUS w/o overt e/o [[Hydronephrosis; Ureterectasis (Hydro;Ureter(o));(nephrosis;ectasis))]]_. Rectal w/o e/o abscess formation, deep space infection or prostatitis_. No e/o [[Epididymo-Orchitis]] on exam. Abdomen benign with minimal suprapubic TTP. No CVAT. Febrile, but otherwise well appearing and reliable. Given dose of [[Ceftriaxone (ROCEPHIN)]] and d/c w/ Cipro_. Cautious return precautions discussed w/ full understanding. [[Appendicitis]] and [[Abdominal Pain]] precautions given for return. Prompt follow up with primary care physician discussed.
PE
PE Benign
Hand Exam
Sensation: SILT in FDWS (radial), SF volar tip (ulnar), and IF (median)
Motor: + TU (radial), OK sign (median), X 2-3 (ulnar), F&E 1-5 against resistance, Wrist/finger extension off table (radial). Finger AB/AD-duction (ulnar), Thumb to pinky (median).
Vascular: CR<2s in all digits
Compartments Soft
Right hand:
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.
Left hand:
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.
Isolation of each digit
IF: FDS, FDP, extenstion intact with PROM and against resistance. No pain on movement. RDN/UDN intact. 2 pt discrimination intact. CR < 2s. Soft compartment. No gross deformity.
MF: FDS, FDP, extenstion intact with PROM and against resistance. No pain on movement. RDN/UDN intact. 2 pt discrimination intact. CR < 2s. Soft compartment. No gross deformity
RF: FDS, FDP, extenstion intact with PROM and against resistance. No pain on movement. RDN/UDN intact. 2 pt discrimination intact. CR < 2s. Soft compartment. No gross deformity
SF: FDS, FDP, extenstion intact with PROM and against resistance. No pain on movement. RDN/UDN intact. 2 pt discrimination intact. CR < 2s. Soft compartment. No gross deformity
Thumb: FPL, EPL, EPB, APL intact per routine. RDN/UDN intact per routine. CR < 2s. No gross deformity. Compartments soft.
ABD [[Right Lower Quadrant (RLQ) Pain]]
Soft, NTND, no rigidity, no rebound, no guarding, Neg. Obturator's Sign, Neg. Psoas Sign.
ABD [[Right Upper Quadrant Pain]]
Soft, NTND, no rigidity, no rebound, no guarding. Neg Murphy's Sign.
Back Exam
Patient can stand on tiptoes, dorsiflex bilaterally, rise bigtes b/l, and can can squat
[[Straight Leg Test]] ***
[[Compartment Syndrome]]
Compartments soft , no pain in compartments on passive stretch, no pallor, warm, + distal pulses, + active movement in ***
DFE (Fundoscopic)
R (Retina): Sharp Disc Margins
M (macula)
V (vessels)
P (periphery)
D (disk)
[[Eye Exam]]
VF ([[Visual Field(s)]]): Intact by 4
VA (Visual Acuity): 20/20 w/ PH
EOM ([[Extraocular Muscle]]s):
Intact w/o diplopia
IOP: 20
GU Male
Testicular exam with normal lie and CMR bilaterally, no significant erythema, tenderness or swelling appreciated. No appreciable [[Inguinal Hernia]] bilaterally. No rashes or lesions. No penile discharge. No blood at meatus.
Head Trauma
No [[Septal hematoma]], TM x2 clear w/o e/o hemotypanum or CSF rhinorrhea, no [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], [[Raccoon eyes]] or csf rhinorrhea, no e/o entrapment, no diplopia on EOM, PERRL, EOMI. No facial tenderness over zygoma, mandible or maxilla. TMJ intact. Midface stable. Nose midline without significant deviation. No ML C-spine TTP.
Knee Exam
Full range of motion of right ankle, right knee without pain, (-) right [[Patellar]] tenderness. Negative mcburney's, negative Lachman's, [[Posterior Drawer Test]]. 5/5 strength of ankle, knee and hip with stable gait. No effusion appreciated.
Neuro Exam
CN2-12 intact b/l. EOMI. 5/5 strength in UE and LE. Intact sensation b/l. No dysmetria, no dysdokinesia. Neg protanator drift, neg romberg. Gait nl.
Pelvic Exam Female
Pelvic Exam: Closed Os, *purulent mucopurulent cervical exudate. *cervix Frability, *cervical erythema, edema. *Adnexal Tenderness, *CMT. *[[Vaginal Vault]] Discharge
Rectal Exam
RECTAL EXAM: no fissures, no [[Hemorrhoid (Pile)]], +brown stool, no [[Melena (Dark Tarry Stool)]], no bright red blood.
SLE
EXT (external structures): normal
LLL (lids lashes and [[Lacrimation]]): No lesions
CS (conjunctiva and sclera): White And Quiet
K (cornea): No Fluorescein Uptake
AC ([[Anterior Chamber]]): Deep and Quiet
I (iris): Round and Reactive
L (lens): Clear
V (vitreous)
[[Shoulder Exam]]
No tenderness to shoulder, no limited flexion and abduction of shoulder secondary to pain, rotator cuff tests are negative. Able to touch opposite shoulder with hand. No deformities. Radian, medial, and ulnar nerves intact to motor and sensation. Good distal pulses and good cap refill
PEAllergicDermatitis
(+) blanching [[Nontender]] mildly pruritic maculopapular centrally confluent rash with satellite lesions over _. Negative nikolsky’s. No perineal, scrotal or mucosal involvement_. No discharge or crusting.
PEAnkle
NVI per routine with appropriate cap refill, extension and flexion of digits, sensation intact to FT throughout
No pain over 1st and 5th MTP
No medial or lateral malleolar tenderness
No proximal tib/fib pain
PEApicalAbscess
(+) small _ cm abscess over interdental papilla of right lower premolar_ between teeth 29 and 30_ with mild gingival thickening, otherwise gingival tissues pink and stipple and firm. No discharge, no blood visualized.
Otherwise, patient with no exudate to bilateral tonsillar beds and no erythema to upper palate or tonsillar beds. No uvular deviation. Full range of motion of neck. No evidence of overt RPA or PTA on exam. Non-elevated [[Tongue]] with soft lower palate. No [[Carotid Artery Bruit]] heard in neck. No petechiae around face or neck. No LAD appreciated. Supple.
PECTLS
No TTP over C/T/L/S midline
PEGUMale
Testicular exam with normal lie and CMR bilaterally, no significant erythema, tenderness or swelling appreciated. No appreciable [[Inguinal Hernia]] bilaterally. No rashes or lesions. No penile discharge. No blood at meatus.
PEGeneral
Comfortably resting, lying in bed, NAD, non[[Sweating]], lucid, fully conversant, no [[Respiratory Distress]], alert and oriented.
PEHand
2+ RP symmetric bilaterally. CR < 2 seconds bilaterally. Neurovascularly intact to radian, median, ulnar per routine to both fine touch and motor in distal hands.
Right hand:
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.
Left hand:
FPL intact per routine. FDS and FDP grossly intact per routine. Extensor mechanisms grossly intact per routine. Able to oppose thumb to pinky. No overt evidence of malrotation. Median recurrent nerve intact to fine touch per routine.
PEHeadTrauma
No [[Septal hematoma]], TM x2 clear w/o e/o hemotypanum or CSF rhinorrhea, no [[Battle Sign ((Postauricular; Mastoid) Ecchymosis)]], [[Raccoon eyes]] or csf rhinorrhea, no e/o entrapment, no diplopia on EOM, PERRL, EOMI. No facial tenderness over zygoma, mandible or maxilla. No malocclusion or [[Tetanus (Tetany; Trismus; Lockjaw)]]. TMJ grossly intact. Midface stable. Nose midline without significant deviation. No ML C-spine TTP.
PEKnee
Full range of motion of right ankle, right knee without pain, (-) right [[Patellar]] tenderness. Negative mcburney’s, negative Lachman’s, [[Posterior Drawer Test]]. 5/5 strength of ankle, knee and hip with stable gait. No effusion appreciated.
PELowerExtremity
No [[Lower Extremity Edema]], asymmetry, erythema or pain. 2+ DP.
PENeuroExam
Mental status: oriented, alert, lucid, cooperative, appropriate.
Cranial nerves: [[CN 2 (Cranial Nerve (Two; II); Optic)]]-12 intact
Motor: 5+ UE and LE, flexors and extensors symmetric.
Sensation: Grossly intact to fine touch UE and LE symmetrically.
Cerebellar: normal FTN bilaterally. No tremor noted.
Gait: normal gait
Tone: normal bulk and tone in upper and lower extremities. No atrophy noted.
PEOpthoExam
Visual Acuity:
OD: 20/20
OS: 20/20
OU: 20/20
No pinhole, no lens
Pupils:
OD: 4à2
OS: 4à2
APD: none
[[IOP (Intraocular Pressure; 10–20 mmHg)]] –
Tp OD: 15
Tp OS: 15
Extraocular motility: FULL OU
Confrontational fields: intact in all fields OU.
[[Slit Lamp]] exam:
Lids and lashes: No edema and no periorbital erythema
Conjunctiva and Sclera: no injection OU
Cornea: no stromal edema, no ED OU
[[Anterior Chamber]]: no cell, no flare OU
Iris: round and reactive OU
Lens: IOL OU
PEPEDSGEN
At baseline, well appearing, smiling, interactive, playing with mother. Nontoxic appearing. No tripoding, no drooling. Verbalization at baseline.
PEPULM
No overt [[Respiratory Distress]]. No tripoding or [[Accessory Muscle Use]]. No cyanosis. No clubbing. No stridor or audible [[Wheez(-e -es; -ing)]]. No visualizable [[Foreign Body]] or mass in [[Upper Airway]].
PEPelvic
Pelvic Exam: Closed Os, no purulent mucopurulent cervical exudate. no cervical friability, no cervical erythema, edema. No Adnexal Tenderness, no CMT. No [[Vaginal Vault]] Discharge or lacerations.
PERashGen
Diffuse nonconfluent pinpoint erythematous blanching [[Papular Rash]] predominately over thorax, extremities_. Pruritic, [[Nontender]], non discharge, some with overlying excoriations without evidence of cellulitis or superinfection. No tenderness to palpation. Negative nikolsky’s. No predominance over flexor creases. No involvement of nails or web spaces of hands.
PESepticJoint
Full range of motion of left ankle_, (+) _ [[Patellar]] tenderness. 5/5 strength of left ankle, knee and hip but limited by pain. Possible small knee effusion on ballotment_. Mild erythema over anterior superior knee _. No pain [[Out of proportion]]; area traced out and observed throughout ED stay without extension. No pain on axial loading. Passive and active ROM to 120 degrees without significant discomfort. + TTP over area of erythema w/o fluctuance. 2+ DP.
PEShoulder
No tenderness to shoulder, no limited flexion and abduction of shoulder secondary to pain, rotator cuff tests are negative. Able to touch opposite shoulder with hand. No deformities. Radian, medial, and ulnar nerves intact to motor and sensation. Good distal pulses and good cap refill.
There is no bruising and no laceration of the skin. The clavicle is not elevated, and the skin is not tented. No sulcus sign when palpating the [[Humeral Head]] and scapula. No scapular tenderness. He has intact [[Axillary Nerve]] sensation. He has no pain or limitation to ROM of elbow, or wrist. He has intact motor distal but limited ROM of the shoulder due to pain.
PEThroat
Patient with no exudate to bilateral tonsillar beds and no erythema to upper palate or tonsillar beds. No uvula deviation. Full range of motion of neck. No evidence of overt RPA or PTA on exam. Non-elevated [[Tongue]] with soft lower palate. No [[Tetanus (Tetany; Trismus; Lockjaw)]]. No [[Carotid Artery Bruit]] heard in neck. No petechiae around face or neck. No LAD appreciated. FROM, supple.
DC
DC[[Numbness]]
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Numbness]] in your _. Your evaluation, including labs and imaging_, suggests that your symptoms are due to __.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for palpitations. Your evaluation suggests _.
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for persistent periods of very rapid heart rate that is associated with [[SOB (Shortness of Breath)]], worsening fatigue with trouble exercising, chest pain, [[Dizziness]], [[Fainting]], or for any other concerning symptoms.
DCPEDSAbdominalPain
Your child has been evaluated in the Olive View-UCLA Emergency Department today. Their evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of the current condition.
Please follow up with your pediatrician within one to two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department immediately if your child has worsening [[Abdominal Pain]], persistent fevers of 100.4°F or greater, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], or any other concerning symptoms.
DCPEDSURI
Your child was evaluated in the Olive View-UCLA Emergency Department today for cough. Their [[PE (Physical Exam(ination))]] suggests that their symptoms are likely due to a viral illness. Viral illnesses should resolve on their own over time. You should give tylenol or motrin as needed using the directions provided to you and give plenty of fluids.
Please follow up with their pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if XXXX experiences worsening cough, trouble breathing, fever, recurrent vomiting, [[Lethargy]], or any other concerning symptoms.
Your child was evaluated in the Olive View-UCLA Emergency Department today for a fever. Their evaluation suggests that the symptoms are likely due to a viral illness_. Viral illnesses should resolve on their own_.
Please alternate Tylenol and Motrin every 4-6 hours to help control fever and give plenty of fluids.
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department immediately if your child experiences persistent fevers greater than 100.4°F that cannot be controlled with Tylenol/Motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], difficulty breathing, or any other concerning symptoms.
Your child has been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your child’s evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your child was observed in the ED without any evidence of neurological instability.
Please follow up with your child’s pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences worsening headaches, vision changes, recurrent vomiting, difficulty with normal activities, [[Lethargy]], abnormal behavior, difficulty walking, weakness, persistent fevers, or any other concerning symptoms.
Your child was evaluated in the Olive View-UCLA Emergency Department today for a laceration. Their laceration was closed with sutures in the Emergency Department. Please keep the area surrounding the laceration clean and dry. To minimize scarring reduce sun exposure for the next year by wearing sunscreen, hats and long clothing.
Please follow up with your pediatrician within two days for a wound check. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences discharge from the laceration, redness around the laceration, warmth around the laceration, persistent fevers, recurrent vomiting, or any other concerning symptoms.
Your child has been evaluated in the Olive View-UCLA Emergency Department today for _ pain. Their evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable_.
Please rest, ice, and elevate to control pain and inflammation. Please give your child tylenol/motrin as directed in the attached dosing instructions for discomfort.
Please follow up with your Pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Please follow up with a pediatric orthopedic surgeon in about 1 week. You can find a pediatric by follow up with a pediatrician.
Return to the Emergency Department if your child experiences worsening pain, change of color in their _, persistent fevers, recurrent vomiting, or any other concerning symptoms.
Your child was evaluated in the Olive View-UCLA Emergency Department today for a rash. Their evaluation suggests _.
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences difficulty breathing or swallowing, lip/mouth/[[Tongue]] swelling, persistent fevers >100.4 that cannot be controlled with tylenol/motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], discharge from his rash, or any other concerning symptoms.
You were examined in the Olive View-UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that _.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with your primary care doctor for an appointment with a urologist. Call (818) 364-3129 if you were not given an appointment time over the phone with an Olive View-UCLA urologist.
Return to the Emergency Department immediately if you experience worsening penile pain, increasing redness or discharge from the penis, fevers or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff_ and have been cleared to go home.
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.
Psychiatric Urgent Care
14659 Olive View Dr.
Sylmar, CA 91342
(818) 485-0888
HRS M-F 8am-10pm Sat-Sun 9am-5:30pm
Return to the Emergency Department immediately if you experience thoughts of hurting yourself or others, audio or [[Visual Hallucinations]], or for any other concerning symptoms.
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a kidney infection ([[Pyelonephritis]]). Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
DCSeizure
You have been evaluated in the Olive View-UCLA Emergency Department today for a seizure. Your evaluation, including labs and CT of your brain, were unremarkable_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Follow up with your primary care doctor to make an appointment with a neurologist. If you were referred to a neurologic here at Olive View-UCLA, please follow up with that appointment which you will be called for.
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
DC INST – ALCOHOL INTOXICATION
DC
You have been evaluated in the Emergency Department today for alcohol intoxication. You have been observed in the Emergency Department and are now able to walk on your own and are tolerating fluids/food.
Please follow up with your primary care physician.
Return to the Emergency Department if you experience shaking, [[Seizure]], palpitations, inability to keep down fluids, worsening or uncontrolled pain, confusion, or for any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged alcohol, discharge, ETOH, tox Leave a comment
DC INST – ALCOHOL INTOXICATION
DC
You have been evaluated in the Emergency Department today for alcohol intoxication. You have been observed in the Emergency Department and are now able to walk on your own and are tolerating fluids/food.
Please follow up with your primary care physician.
Return to the Emergency Department if you experience shaking, [[Seizure]], palpitations, inability to keep down fluids, worsening or uncontrolled pain, confusion, or for any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged alcohol, discharge, ETOH, tox Leave a comment
DC INST – EPISTAXIS
DC
You have been evaluated in the Emergency Department today for your [[Nose Bleed (Epistaxis)]]. Your bleeding was controlled in the ER with pressure. Your bleeding was most likely caused by dry and fragile skin inside your nose.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening or uncontrolled bleeding, [[SOB (Shortness of Breath)]], feeling lightheaded or dizzy, [[LOC (Loss (Of) Consciousness)]], [[Fainting]], nausea or vomiting, chest pain, or for any other concerning symptoms.
Thank you for choosing usfor your care.
DC INST – FRACTURE GENERIC
DC
You have been evaluated in the Emergency Department today for * pain. Your evaluation showed a fracture of your *. We have placed your *** in a splint today, avoid getting the splint wet.
Please rest, ice, and elevate your * to help it heal. *We have provided crutches for you to use at home while your *** heals.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. *** Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.
Please follow-up with an orthopedic surgeon in 1 week.
Return to the Emergency Department if you experience worsening pain, [[Numbness]], tingling, change of color in your ***, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, fracture, msk, ortho Leave a comment
DC INST – FRACTURE GENERIC
DC
You have been evaluated in the Emergency Department today for * pain. Your evaluation showed a fracture of your *. We have placed your *** in a splint today, avoid getting the splint wet.
Please rest, ice, and elevate your * to help it heal. *We have provided crutches for you to use at home while your *** heals.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. *** Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.
Please follow-up with an orthopedic surgeon in 1 week.
Return to the Emergency Department if you experience worsening pain, [[Numbness]], tingling, change of color in your ***, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, fracture, msk, ortho Leave a comment
DC INST – G TUBE REPLACEMENT
DC
You have been evaluated in the Emergency Department today for a problem with your G-tube. Your G-tube was replaced in the ER and you had imaging to confirm placement.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience fevers, vomiting, redness, swelling, or discharge from the G-tube site, if your G-tube falls out, if you are unable to use the G-tube, for pain with using the G-tube, or for any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, g-tube, gastric tube, gi Leave a comment
DC INST – G TUBE REPLACEMENT
DC
You have been evaluated in the Emergency Department today for a problem with your G-tube. Your G-tube was replaced in the ER and you had imaging to confirm placement.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience fevers, vomiting, redness, swelling, or discharge from the G-tube site, if your G-tube falls out, if you are unable to use the G-tube, for pain with using the G-tube, or for any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, g-tube, gastric tube, gi Leave a comment
DC INST – [[Gastritis]]
DC
You were evaluated in the Emergency Department today for [[Epigastric (Abdominal) Pain]], which is most likely due to irritation of the lining of your stomach. Your symptoms improved with medication in the ED. You can take Mylanta, which is available over the counter, to help manage your symptoms. Avoid spicy or acidic foods.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience [[SOB (Shortness of Breath)]], worsening or uncontrolled abdominal or chest pain, headache, light headedness, feeling faint, nausea, vomiting, bloody vomit or stools, [[Black Tarry Stool]]s, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, [[Gastritis]], gi Leave a comment
DC INST – [[Gastroenteritis]]
DC
You have been evaluated in the Emergency Department today for [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to viral illness which will improve on its own with rest and fluids. Remember to drink plenty of fluids at home.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, [[Gastroenteritis]], gi, nausea, vomiting Leave a comment
DC INST – HEAD INJURY (CT)
DC
You have been evaluated in the Emergency Department today for your head injury. Your CT scan did not show signs of bleeds or fractures in your head.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please schedule an appointment for follow up with your primary care physician as soon as possible.
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged closed head injury, CT, discharge, neuro Leave a comment
DC INST – HEAD INJURY (CT)
DC
You have been evaluated in the Emergency Department today for your head injury. Your CT scan did not show signs of bleeds or fractures in your head.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please schedule an appointment for follow up with your primary care physician as soon as possible.
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged closed head injury, CT, discharge, neuro Leave a comment
DC INST – HEADACHE
DC
You have been evaluated in the Emergency Department today for headache. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time, and your pain improved with medication in the ED.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, headache, neuro Leave a comment
DC INST – [[Hemorrhoid (Pile)]]
DC
You have been evaluated in the Emergency Department today for your [[Rectal Pain]]. Your evaluation has revealed that your symptoms are due to [[Hemorrhoid (Pile)]]. You can apply [[Phenylephrine (Hemorrhoid (Piles)) Cream (PREPARATION H)]], which is available over the counter, and do [[Sitz Bath]]s to soothe the area. Stay well hydrated, eat a [[High Fiber (Diet; Intake)]], and take stool softeners- you should not strain on the toilet.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening bleeding, feel lightheaded, have [[SOB (Shortness of Breath)]], have headache, feel weak, have fever, or for any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, gi, [[Hemorrhoid (Pile)]] Leave a comment
DC INST – KNEE PAIN
DC
You were evaluated in the Emergency Department today for your knee pain. Your evaluation, including ***X-rays of your knee, did not show signs of fractures or other acute abnormalities which require further intervention at this time.
Your knee has been ace wrapped and you were given crutches in the ER to help your knee heal. Please rest, ice and elevate your knee, and resume normal activities as tolerated.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. ***Please take your prescribed norco as directed as necessary for pain. Do not drive or take medications containing tylenol while taking norco.
Please follow up with your primary care physician within three days.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]], tingling, or weakness to your legs, difficulty walking, worsening knee swelling or redness, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, knee pain, msk, ortho Leave a comment
DC INST – KNEE PAIN
DC
You were evaluated in the Emergency Department today for your knee pain. Your evaluation, including ***X-rays of your knee, did not show signs of fractures or other acute abnormalities which require further intervention at this time.
Your knee has been ace wrapped and you were given crutches in the ER to help your knee heal. Please rest, ice and elevate your knee, and resume normal activities as tolerated.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. ***Please take your prescribed norco as directed as necessary for pain. Do not drive or take medications containing tylenol while taking norco.
Please follow up with your primary care physician within three days.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]], tingling, or weakness to your legs, difficulty walking, worsening knee swelling or redness, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, knee pain, msk, ortho Leave a comment
DC INST – LAC REPAIR
DC
You have been evaluated in the Emergency Department today for a laceration to your ***. Your laceration was repaired in the ED with sutures. Please keep the area surrounding the laceration clean and dry. Please keep the area out of the sunlight for the next 6 months to help prevent scarring. You should have the sutures removed in 7-10 days by your primary care physician, or at your local urgent care or ER. If you develop redness or swelling at the site of your laceration please come back to the ER for a wound check.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please follow up with your primary care physician in 7-10 days for suture removal. You can also return to the ER or another urgent care facility for this service.
Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, [[Numbness]], tingling, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged derm, discharge, laceration, msk, ortho Leave a comment
DC INST – LAC REPAIR
DC
You have been evaluated in the Emergency Department today for a laceration to your ***. Your laceration was repaired in the ED with sutures. Please keep the area surrounding the laceration clean and dry. Please keep the area out of the sunlight for the next 6 months to help prevent scarring. You should have the sutures removed in 7-10 days by your primary care physician, or at your local urgent care or ER. If you develop redness or swelling at the site of your laceration please come back to the ER for a wound check.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please follow up with your primary care physician in 7-10 days for suture removal. You can also return to the ER or another urgent care facility for this service.
Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, [[Numbness]], tingling, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged derm, discharge, laceration, msk, ortho Leave a comment
DC INST – MENSTRUAL CRAMPS
DC
You have been evaluated in the Emergency Department today for your cramping [[Abdominal Pain]]. Your evaluation suggests that your symptoms are due to menstrual cramps.
Please take [[Ibuprofen; ((ADVIL), (MOTRIN))]] up to 600mg every 6 hours to control pain. You can also use heating or cooling packs.
Please follow up with your primary care physician within 1 week. You can find a primary care doctor at UCLA by calling 310-825-2631. You can call (310) 794-7274 to schedule an appointment with a UCLA OB/Gyn.
Return to the Emergency Department if you experience [[Vaginal Bleeding]], [[SOB (Shortness of Breath)]], feeling lightheaded, chest [[Tightness]], worsening or uncontrolled pain, fevers 100.4°F or greater, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Leave a comment
DC INST – MENSTRUAL CRAMPS
DC
You have been evaluated in the Emergency Department today for your cramping [[Abdominal Pain]]. Your evaluation suggests that your symptoms are due to menstrual cramps.
Please take [[Ibuprofen; ((ADVIL), (MOTRIN))]] up to 600mg every 6 hours to control pain. You can also use heating or cooling packs.
Please follow up with your primary care physician within 1 week. You can find a primary care doctor at UCLA by calling 310-825-2631. You can call (310) 794-7274 to schedule an appointment with a UCLA OB/Gyn.
Return to the Emergency Department if you experience [[Vaginal Bleeding]], [[SOB (Shortness of Breath)]], feeling lightheaded, [[Chest Tightness]], worsening or uncontrolled pain, fevers 100.4°F or greater, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Leave a comment
DC INST – MSK PAIN
DC
You have been evaluated in the Emergency Department today for *** pain. Your evaluation did not find evidence of medical conditions requiring emergent intervention at this time.
We have provided crutches for you to use while your * heals. Please rest, ice, and elevate your *, and resume normal activities as tolerated.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please schedule an appointment for follow up with your primary care physician this week.
Return to the Emergency Department if you experience worsening pain, [[Numbness]], tingling, change of color in your toes, or any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged discharge, msk, [[MSK (Musculoskeletal)]], ortho Leave a comment
DC INST – MSK PAIN
DC
You have been evaluated in the Emergency Department today for *** pain. Your evaluation did not find evidence of medical conditions requiring emergent intervention at this time.
We have provided crutches for you to use while your * heals. Please rest, ice, and elevate your *, and resume normal activities as tolerated.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please schedule an appointment for follow up with your primary care physician this week.
Return to the Emergency Department if you experience worsening pain, [[Numbness]], tingling, change of color in your toes, or any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged discharge, msk, [[[MSK (Musculoskeletal)]]](https://natedotphrase.com/tag/[[MSK (Musculoskeletal)]]/), ortho Leave a comment
DC INST – MUSCLE STRAIN
DC
You have been evaluated in the Emergency Department today for your pain after ___. Your pain is most likely muscle strain which will improve on its own.
Please follow up with your primary care physician in 2-3 days.
Please rest, ice, and elevate your to control pain and inflammation.
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your , color change to your , or for any other concerning symptoms.
Thank you for choosing us for your care
April 12, 2018 Tagged discharge, msk, muscle strain, ortho Leave a comment
DC INST – MUSCLE STRAIN
DC
You have been evaluated in the Emergency Department today for your pain after ___. Your pain is most likely muscle strain which will improve on its own.
Please follow up with your primary care physician in 2-3 days.
Please rest, ice, and elevate your to control pain and inflammation.
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your , color change to your , or for any other concerning symptoms.
Thank you for choosing us for your care
April 12, 2018 Tagged discharge, msk, muscle strain, ortho Leave a comment
DC INST – MVC
DC
You have been evaluated in the Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
***Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.
Please follow up with your primary care physician in 2-3 days.
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged discharge, mva, mvc Leave a comment
DC INST – NOSE INJURY
DC
You have been evaluated in the Emergency Department today for your nose injury after a fall. Your nose does not appear to be fractured.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please follow up with your primary care physician in 2-3 days. If your nose appears to be deformed in 3-4 days, you can find a plastic surgeon by calling (310) 825-5510 or an Ear, Nose, and Throat physician by calling 310-206-6688.
Return to the ER immediately for vomiting, confusion, worsening or uncontrolled pain, difficulty breathing, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged discharge, ent, face, nasal fracture Leave a comment
DC INST – NOSE INJURY
DC
You have been evaluated in the Emergency Department today for your nose injury after a fall. Your nose does not appear to be fractured.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please follow up with your primary care physician in 2-3 days. If your nose appears to be deformed in 3-4 days, you can find a plastic surgeon by calling (310) 825-5510 or an Ear, Nose, and Throat physician by calling 310-206-6688.
Return to the ER immediately for vomiting, confusion, worsening or uncontrolled pain, difficulty breathing, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged discharge, ent, face, nasal fracture Leave a comment
DC INST – PENILE PAIN
DC
You were examined in the UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that XXXX.
Please follow up with your primary care physician within two days.
Return to the Emergency Department immediately if you experience worsening penile pain, increasing discharge or redness from the penis, fevers or any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged discharge, gu, penile Leave a comment
DC INST – PENILE PAIN
DC
You were examined in the UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that XXXX.
Please follow up with your primary care physician within two days.
Return to the Emergency Department immediately if you experience worsening penile pain, increasing discharge or redness from the penis, fevers or any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged discharge, gu, penile Leave a comment
DC INST – [[Peritonsillar Abscess]]
DC
You have been evaluated in the Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation has revealed an early, small [[Peritonsillar Abscess]]. Your abscess was incised and drained in the Emergency Department.
Please take your prescribed antibiotics for the full course of the medication.
Please follow up with a Head and Neck doctor in about 1 week.
Return to the ER immediately for worsening or uncontrolled pain, difficulty swallowing, eating, or breathing, pain on moving your jaw, [[Tongue]] swelling, fevers 100.4°F or greater, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged abscess, discharge, ent, PTA, throat Leave a comment
DC INST – PERITONSILLAR ABSCESS
DC
You have been evaluated in the Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation has revealed an early, small [[Peritonsillar Abscess]]. Your abscess was incised and drained in the Emergency Department.
Please take your prescribed antibiotics for the full course of the medication.
Please follow up with a Head and Neck doctor in about 1 week.
Return to the ER immediately for worsening or uncontrolled pain, difficulty swallowing, eating, or breathing, pain on moving your jaw, [[Tongue]] swelling, fevers 100.4°F or greater, or for any other concerning symptoms.
Thank you for choosing us for your care.
DC INST – PSYCH
DC
You have been evaluated in the Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff and have been cleared to go home.
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.
Return to the Emergency Department if you experience thoughts of hurting yourself or others, audio or visual [[Hallucinations]], or for any other concerning symptoms.
April 16, 2018 Tagged DC, psych Leave a comment
DC INST – RASH
DC
You were evaluated in the Emergency Department today for a rash. Your evaluation suggests your symptoms are most likely due to ***.
Please follow up with your primary care physician within 2-3 days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.
Return to the Emergency Department if you experience worsening or spreading rash, worsening or uncontrolled pain, fevers 100.4°F or greater, recurrent vomiting, [[SOB (Shortness of Breath)]], discharge from your rash, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, derm, rash Leave a comment
DC INST – [[Renal Colic]]
DC
You have been evaluated in the Emergency Department today for your flank pain. Your pain is most likely due to a kidney stone which will pass on its own.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening pain, fever, painful urination, [[Blood In Urine]], weakness, chest pain, difficulty breathing or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, [[Nephrolithiasis ((Kidney; Renal) Stone(s))]], renal Leave a comment
DC INST – RENAL COLIC
DC
You have been evaluated in the Emergency Department today for your flank pain. Your pain is most likely due to a [[Nephrolithiasis ((Kidney; Renal) Stone(s))]] which will pass on its own.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening pain, fever, painful urination, [[Blood In Urine]], weakness, chest pain, difficulty breathing or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, [[Nephrolithiasis ((Kidney; Renal) Stone(s))]]](https://natedotphrase.com/tag/[[Nephrolithiasis ((Kidney; Renal) Stone(s))]]/), renal Leave a comment
DC INST – SEIZURE
DC
You have been evaluated in the Emergency Department today for a seizure. Your evaluation, including labs and a CT of your brain, were unremarkable. Do not drive until you are cleared by a physician.
Please follow up with your primary care physician within two days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, neuro, seizure Leave a comment
DC INST – [[SOB (Shortness of Breath)]]
DC
You were evaluated in the Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Steroid]], and your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. ***You have been given a prescription for [[Steroid]], please take them as directed.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, headache, light headedness, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, [[Dyspnea]], pulm, SOB Leave a comment
DC INST – SHORTNESS OF BREATH
DC
You were evaluated in the Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Steroid]], and your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. ***You have been given a prescription for [[Steroid]], please take them as directed.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, headache, light headedness, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, [[Dyspnea]]](https://natedotphrase.com/tag/[[Dyspnea]]/), pulm, SOB Leave a comment
DC INST – SHOULDER DISLOCATION
DC
You have been evaluated in the Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, revealed a shoulder dislocation. We have reduced your shoulder, please use the sling for comfort.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. ***Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.
Please follow up with your primary care physician within two days.
Please follow up with an orthopedic surgeon in 1 week.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your fingers, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, dislocation, ortho, shoulder Leave a comment
DC INST – SHOULDER DISLOCATION
DC
You have been evaluated in the Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, revealed a shoulder dislocation. We have reduced your shoulder, please use the sling for comfort.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]]. ***Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.
Please follow up with your primary care physician within two days.
Please follow up with an orthopedic surgeon in 1 week.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your fingers, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, dislocation, ortho, shoulder Leave a comment
DC INST – [[Sore Throat (Pharyngitis)]]
DC
You have been evaluated in the Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests your symptoms are due to ***.
***Please take your prescribed antibiotics as directed for the full course of the medication.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, change in your voice, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, [[Sore Throat (Pharyngitis)]], sore throat Leave a comment
DC INST – SORE THROAT
DC
You have been evaluated in the Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests your symptoms are due to ***.
***Please take your prescribed antibiotics as directed for the full course of the medication.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, change in your voice, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, pharyngitis, [[Sore Throat (Pharyngitis)]]](https://natedotphrase.com/tag/sore-throat/) Leave a comment
DC INST – STI
DC
You have been evaluated in the Emergency Department today for your ***. You were tested today for [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] and the results are still pending; you have been given treatment for these infections presumptively anyway. You will receive a phone call in~3 days if the results are positive. You should follow up with your primary care provider for further STI testing.
***Please take your prescribed antibiotics for the full course of the medication as directed.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged antibiotics, DC, gu, sti Leave a comment
DC INST – SUTURE REMOVAL
DC
You have been evaluated in the Emergency Department today for suture removal. Your sutures were removed and your wound is healing well. You can wash the area freely now. Keep your wound out of the sunlight for six months to reduce the appearance of scarring. You should cover your scar or use high SPF sunscreen protection.
Please follow up with your primary care doctor at your next scheduled appointment.
Return to the ER immediately signs of infection to your wounds such as worsening pain, worsening redness/swelling, discharge/pus from your wounds, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, suture removal Leave a comment
DC INST – SUTURE REMOVAL
DC
You have been evaluated in the Emergency Department today for suture removal. Your sutures were removed and your wound is healing well. You can wash the area freely now. Keep your wound out of the sunlight for six months to reduce the appearance of scarring. You should cover your scar or use high SPF sunscreen protection.
Please follow up with your primary care doctor at your next scheduled appointment.
Return to the ER immediately signs of infection to your wounds such as worsening pain, worsening redness/swelling, discharge/pus from your wounds, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, suture removal Leave a comment
DC INST – UPPER RESPIRATORY
DC
You were evaluated in the Emergency Department today for your congestion, cough and fevers. Your evaluation suggests that your symptoms are most likely due to a viral illness, which will improve on its own with rest and fluids.
***We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for fever. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please schedule an appointment for follow up with your primary care physician this week.
Return to the Emergency Department if you experience worsening cough, fever 100.4 ° F or greater not controlled by Tylenol or [[Ibuprofen; ((ADVIL), (MOTRIN))]], recurrent vomiting, chest pain, [[SOB (Shortness of Breath)]], or any other concerning symptoms.
Thank you for choosing UCLA for your care.
April 16, 2018 Tagged cough, DC, pulm Leave a comment
DC INST – UPPER RESPIRATORY
DC
You were evaluated in the Emergency Department today for your congestion, cough and fevers. Your evaluation suggests that your symptoms are most likely due to a viral illness, which will improve on its own with rest and fluids.
***We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for fever. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please schedule an appointment for follow up with your primary care physician this week.
Return to the Emergency Department if you experience worsening cough, fever 100.4 ° F or greater not controlled by Tylenol or [[Ibuprofen; ((ADVIL), (MOTRIN))]], recurrent vomiting, chest pain, [[SOB (Shortness of Breath)]], or any other concerning symptoms.
Thank you for choosing UCLA for your care.
April 16, 2018 Tagged cough, DC, pulm Leave a comment
DC INST – UTI
DC
You have been evaluated in the Emergency Department today for your urinary symptoms. Your evaluation, including urinalysis, suggests that your symptoms are due to a [[UTI (Urinary Tract Infection)]]. Please take your prescribed antibiotics for the full course of the medication as directed.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, vomiting, flank pain, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged antibiotics, DC, urinary tract, uti Leave a comment
DC INST – [[Vaginal Bleeding]]
DC
You have been evaluated in the UCLA Emergency Department today for your [[Vaginal Bleeding]]. Your evaluation suggests that your symptoms are due to *. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] showed *.
Please follow up with your primary care physician within two days.
***Please follow up with your OB/Gyn within 2 days.
Return to the Emergency Department if you experience worsening or uncontrolled bleeding, [[SOB (Shortness of Breath)]], feeling lightheaded, [[Chest Tightness]], abdominal cramping, severe [[Abdominal Pain]], fevers,vomiting, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, gyn, [[Vaginal Bleeding]] Leave a comment
DC INST – VAGINAL BLEEDING
DC
You have been evaluated in the UCLA Emergency Department today for your [[Vaginal Bleeding]]. Your evaluation suggests that your symptoms are due to *. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] showed *.
Please follow up with your primary care physician within two days.
***Please follow up with your OB/Gyn within 2 days.
Return to the Emergency Department if you experience worsening or uncontrolled bleeding, [[SOB (Shortness of Breath)]], feeling lightheaded, [[Chest Tightness]], abdominal cramping, severe [[Abdominal Pain]], fevers,vomiting, or for any other concerning symptoms.
Thank you for choosing us for your care.
__April 16, 2018 Tagged DC, gyn, [[Vaginal Bleeding]]
DC INST – [[Vasovagal Syncope]]
DC
You have been evaluated in the Emergency Department today for your syncopal episode. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time, however we recommend you follow up with your primary care provider for further testing as an outpatient.
Please follow up with your primary care doctor in 2-3 days.
Return to the ER immediately for worsening or uncontrolled symptoms, headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, neuro, syncope Leave a comment
DC INST – VASOVAGAL SYNCOPE
DC
You have been evaluated in the Emergency Department today for your syncopal episode. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time, however we recommend you follow up with your primary care provider for further testing as an outpatient.
Please follow up with your primary care doctor in 2-3 days.
Return to the ER immediately for worsening or uncontrolled symptoms, headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, neuro, syncope Leave a comment
DC INST – VOMITING
DC
You have been evaluated in the Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely to do a viral infection which will improve on its own with rest and fluids.
Please follow up with your primary care physician within two days.
Remember to drink plenty of fluids at home.
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
Thank you for choosing for your care.
April 16, 2018 Tagged DC, gastro, vomiting Leave a comment
DC INST – WRIST PAIN
DC
You have been evaluated in the Emergency Department today for wrist pain after a fall. Your evaluation, including [[PE (Physical Exam(ination))]] and x-ray, has revealed that you have a fracture of your ___ // no evidence of any acute fractures or dislocations.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package. Please also rest, ice, and elevate your arm to control pain and inflammation.
Please follow up with your primary care physician within two days. If your pain persists in 7- 10 days please have repeat x-ray. // Please follow up with an orthopedic surgeon within 1 week.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, msk, wrist Leave a comment
DC INST – WRIST PAIN
DC
You have been evaluated in the Emergency Department today for wrist pain after a fall. Your evaluation, including [[PE (Physical Exam(ination))]] and x-ray, has revealed that you have a fracture of your ___ // no evidence of any acute fractures or dislocations.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package. Please also rest, ice, and elevate your arm to control pain and inflammation.
Please follow up with your primary care physician within two days. If your pain persists in 7- 10 days please have repeat x-ray. // Please follow up with an orthopedic surgeon within 1 week.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, msk, wrist Leave a comment
DC INST – EPISTAXIS
DC
You have been evaluated in the Emergency Department today for your [[Nose Bleed (Epistaxis)]]. Your bleeding was controlled in the ER with pressure. Your bleeding was most likely caused by dry and fragile skin inside your nose.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening or uncontrolled bleeding, [[SOB (Shortness of Breath)]], feeling lightheaded or dizzy, [[LOC (Loss (Of) Consciousness)]], [[Fainting]], nausea or vomiting, chest pain, or for any other concerning symptoms.
Thank you for choosing usfor your care.
DC INST – [[Gastritis]]
DC
You were evaluated in the Emergency Department today for [[Epigastric (Abdominal) Pain]], which is most likely due to irritation of the lining of your stomach. Your symptoms improved with medication in the ED. You can take Mylanta, which is available over the counter, to help manage your symptoms. Avoid spicy or acidic foods.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience [[SOB (Shortness of Breath)]], worsening or uncontrolled abdominal or chest pain, headache, light headedness, feeling faint, nausea, vomiting, bloody vomit or stools, [[Black Tarry Stool]]s, or any other concerning symptoms.
Thank you for choosing us for your care.
[January 16, 2018](https://natedotphrase.com/2018/01/16/dc-inst-[[Gastritis]]/) Tagged discharge, [[[Gastritis]]](https://natedotphrase.com/tag/[[Gastritis]]/), gi [Leave a comment](https://natedotphrase.com/2018/01/16/dc-inst-[[Gastritis]]/#respond)
DC INST – [[Gastroenteritis]]
DC
You have been evaluated in the Emergency Department today for [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to viral illness which will improve on its own with rest and fluids. Remember to drink plenty of fluids at home.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
Thank you for choosing us for your care.
[January 16, 2018](https://natedotphrase.com/2018/01/16/dc-inst-[[Gastroenteritis]]/) Tagged discharge, [[[Gastroenteritis]]](https://natedotphrase.com/tag/[[Gastroenteritis]]/), gi, nausea, vomiting [Leave a comment](https://natedotphrase.com/2018/01/16/dc-inst-[[Gastroenteritis]]/#respond)
DC INST – HEADACHE
DC
You have been evaluated in the Emergency Department today for headache. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time, and your pain improved with medication in the ED.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.
Thank you for choosing us for your care.
January 16, 2018 Tagged discharge, headache, neuro Leave a comment
DC INST – [[Hemorrhoid (Pile)]]
DC
You have been evaluated in the Emergency Department today for your [[Rectal Pain]]. Your evaluation has revealed that your symptoms are due to [[Hemorrhoid (Pile)]]. You can apply [[Phenylephrine (Hemorrhoid (Piles)) Cream (PREPARATION H)]], which is available over the counter, and do [[Sitz Bath]]s to soothe the area. Stay well hydrated, eat a [[High Fiber (Diet; Intake)]], and take stool softeners- you should not strain on the toilet.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience worsening bleeding, feel lightheaded, have [[SOB (Shortness of Breath)]], have headache, feel weak, have fever, or for any other concerning symptoms.
Thank you for choosing us for your care.
[January 16, 2018](https://natedotphrase.com/2018/01/16/dc-inst-[[Hemorrhoid (Pile)]]/) Tagged discharge, gi, [[[Hemorrhoid (Pile)]]](https://natedotphrase.com/tag/[[Hemorrhoid (Pile)]]/) [Leave a comment](https://natedotphrase.com/2018/01/16/dc-inst-[[Hemorrhoid (Pile)]]/#respond)
DC INST – MVC
DC
You have been evaluated in the Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation did not show evidence of medical conditions requiring emergent intervention at this time. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.
We recommend you take 600mg [[Ibuprofen; ((ADVIL), (MOTRIN))]] every 6 hours or tylenol 650mg every 6 hours as needed for pain. If needed, you can alternate these medications so that you take one medication every 3 hours. For instance, at noon take [[Ibuprofen; ((ADVIL), (MOTRIN))]], then at 3pm take tylenol, then at 6pm take [[Ibuprofen; ((ADVIL), (MOTRIN))]].
***Please take your prescribed norco as directed as necessary for breakthrough pain. Do not drive or take medications containing tylenol while taking norco.
Please follow up with your primary care physician in 2-3 days.
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 12, 2018 Tagged discharge, mva, mvc Leave a comment
DC INST – PSYCH
DC
You have been evaluated in the Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff and have been cleared to go home.
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.
Return to the Emergency Department if you experience thoughts of hurting yourself or others, audio or [[Visual Hallucinations]], or for any other concerning symptoms.
April 16, 2018 Tagged DC, psych Leave a comment
DC INST – RASH
DC
You were evaluated in the Emergency Department today for a rash. Your evaluation suggests your symptoms are most likely due to ***.
Please follow up with your primary care physician within 2-3 days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.
Return to the Emergency Department if you experience worsening or spreading rash, worsening or uncontrolled pain, fevers 100.4°F or greater, recurrent vomiting, [[SOB (Shortness of Breath)]], discharge from your rash, or any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, derm, rash Leave a comment
DC INST – SEIZURE
DC
You have been evaluated in the Emergency Department today for a seizure. Your evaluation, including labs and a CT of your brain, were unremarkable. Do not drive until you are cleared by a physician.
Please follow up with your primary care physician within two days. Call 1-800-825-2631 to schedule an appointment with a primary care physician.
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged DC, neuro, seizure Leave a comment
DC INST – STI
DC
You have been evaluated in the Emergency Department today for your ***. You were tested today for [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] and the results are still pending; you have been given treatment for these infections presumptively anyway. You will receive a phone call in~3 days if the results are positive. You should follow up with your primary care provider for further STI testing.
***Please take your prescribed antibiotics for the full course of the medication as directed.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged antibiotics, DC, gu, sti Leave a comment
DC INST – UTI
DC
You have been evaluated in the Emergency Department today for your urinary symptoms. Your evaluation, including urinalysis, suggests that your symptoms are due to a [[UTI (Urinary Tract Infection)]]. Please take your prescribed antibiotics for the full course of the medication as directed.
Please follow up with your primary care physician within two days.
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, vomiting, flank pain, or for any other concerning symptoms.
Thank you for choosing us for your care.
April 16, 2018 Tagged antibiotics, DC, urinary tract, uti Leave a comment
DC INST – VOMITING
DC
You have been evaluated in the Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely to do a viral infection which will improve on its own with rest and fluids.
Please follow up with your primary care physician within two days.
Remember to drink plenty of fluids at home.
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
Thank you for choosing for your care.
April 16, 2018 Tagged DC, gastro, vomiting Leave a comment
DCAMA
You have been evaluated in the Olive View-UCLA Emergency Department today. You are refusing further testing, imaging, and further admission and choosing to leave [[AMA (Against Medical Advice)]]. You were advised of your risks of leaving and understand that permanent harm, or even death, can occur from failing to follow the recommendations of the physician.
Please follow up with your primary care physician within one day. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.
Return to the Emergency Department immediately if you experience worsening or uncontrolled pain, persistent fevers, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], chest pain, [[SOB (Shortness of Breath)]], or for any other concerning symptoms.
DCAbdPain
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Abdominal Pain]]. Your evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of your current condition.
Return to the ER if your pain does not resolve within 8-12 hours or worsens. Please follow up with your primary care physician within one to two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], chest pain, difficulty breathing, or any other concerning symptoms.
DCAbscessID
You were evaluated in the Olive View-UCLA Emergency Department for an abscess. Your abscess was incised and drained in the Emergency Department. We have inserted a loose gauze in the abscess pocket to promote drainage and applied a clean dressing over it. You will need to change the dressing every 24 hours. Please keep the areas surrounding the abscess clean and dry. Take the antibiotics prescribed to you in full as directed.
Follow up with your primary care physician within 2 days for a wound check. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, an increase in area of redness, increased tenderness/warmth around the abscess, [[Foul Smelling]] discharge from the abscess, or any other concerning symptoms.
DCAbscessNoID
You were evaluated in the Olive View-UCLA Emergency Department for an abscess. You should soak the area in warm water for 20-30 minutes 3-4 times daily. Contact your doctor when the abscess comes to a head and needs to be drained. Please keep the areas surrounding the abscess clean and dry. Take the antibiotics prescribed to you in full as directed.
Follow up with your primary care physician within 2 days for a wound check. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, persistent fevers greater than 100.4, an increase in area of redness, increased tenderness/warmth around the abscess, [[Foul Smelling]] discharge from the abscess, or any other concerning symptoms.
DCAllergicReaction
You have been evaluated in the Olive View-UCLA Emergency Department today for your allergic reaction. You have been given medications including [[Steroid]], [[Epinephrine (Adrenaline)]], and [[Diphenhydramine (BENADRYL®)]] to control your swelling. You have been observed in the Emergency Department and it appears that your symptoms will not return.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience difficulty breathing or swallowing, recurrent vomiting, rashes, lip/mouth/[[Tongue]] swelling, persistent fevers or for any other concerning symptoms.
Thank you for choosing Olive-ViewUCLA for your care.
DCAnkle
You have been evaluated in the Olive View-UCLA Emergency Department today for ankle pain. The x-ray of your ankle _.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your ankle to control your pain.
Please follow up with your primary care physician within two days as needed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.
DCAnxiety
You have been evaluated in the Olive View-UCLA Emergency Department today for your anxiety. Your symptoms have resolved in the Emergency Department.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience new or worsening anxiety, depression, thoughts of harming yourself or others, or for any other concerning symptoms.
DC[[Asthma]]
You were evaluated in the Olive View-UCLA Emergency Department today for an acute exacerbation of your [[Asthma]]. Your symptoms improved receiving an albuterol breathing treatment.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms.
DCBackPain
You were evaluated in the Olive View-UCLA Emergency Department today for [[Back Pain (Dolor)]]. Your evaluation suggests no acute abnormalities which require further intervention at this time.
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain. You should continue doing back exercises which could include going to [[Physical Therapy]].
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening [[Back Pain (Dolor)]], incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.
DCCellulitis
You have been evaluated in the Olive View-UCLA Emergency Department today for a skin infection. Please take the prescribed antibiotics as directed for the full course of the medication.
Follow up with your primary care physician within 2 days for a re-evaluation of the skin infection to make sure it has not spread and is getting better. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience an increase in area of redness, persistent fevers, increased tenderness/warmth around the skin infection, or any other concerning symptoms
DCChestPain
You have been evaluated in the Olive View-UCLA Emergency Department today for chest pain. Your evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your EKG did not show any acute changes.
Please follow up with your primary care doctor in 2 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening chest pain, palpitations, [[SOB (Shortness of Breath)]], persistent vomiting, [[Fainting]], or for any other concerning symptoms.
DCCough
You were evaluated in the Olive View-UCLA Emergency Department today for a cough. Your evaluation suggests _.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening cough, fever, [[SOB (Shortness of Breath)]], recurrent vomiting, [[Lethargy]], or any other concerning symptoms.
DCCystitis
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed_.
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
DCCystitis
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed_.
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
DCDentalPain
You have been evaluated in the Olive View-UCLA Emergency Department today for your dental pain. Your pain has been controlled with __. Your [[PE (Physical Exam(ination))]] suggests no acute abnormalities which require further intervention at this time.
Please follow up with your [[Dentist]] tomorrow. Call to schedule an appointment with a [[Dentist]]ry clinic.
Return to the Emergency Department if you experience worsening or uncontrolled pain, fevers 100.4°F or greater, vomiting, [[Tongue]] swelling, throat swelling, or any other concerning symptoms.
DC[[Dizziness]]
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Dizziness]]. Your evaluation suggests _.
You have been prescribed _ to help relieve your symptoms. Please take your prescription as directed.
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, [[Fainting]], or for any other concerning symptoms
DC[[Dysuria]]
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take as directed in full_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
DCETOH
You have been evaluated in the Olive View UCLA Emergency Department today for alcohol intoxication. You are now able to walk on your own and are tolerating fluids/food.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience inability to keep down fluids, worsening or uncontrolled pain, confusion, or for any other concerning symptoms.
LA Country Drug Abuse and Prevention
http://publichealth.lacounty.gov/sapc/findtreatment.htm
Call: 800-564-6600
DCEarPain
You were evaluated in the Olive View-UCLA Emergency Department today for ear pain. Your [[PE (Physical Exam(ination))]] suggests that you have an ear infection_. Please take the antibiotics in full as directed_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience [[HL (Hearing Loss; Deafness)]], discharge from your ear, headaches, fevers, recurrent vomiting, or any other concerning symptoms.
DCElbowPain
You have been evaluated in the Olive View-UCLA Emergency Department today for elbow pain. Your evaluation, including physical exam and x-rays, were unremarkable// reveal a fracture_.
Please use the sling for comfort_. You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with an orthopedic surgeon in about 1 week. If we referred you to the olive view specialists, please follow up with your appointment. Please call 818-364-3676 if you do not receive a call for an appointment time.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.
DCEpistaxis
You have been evaluated in the Olive View-UCLA Emergency Department today for a [[Nose Bleed (Epistaxis)]]. The bleeding was controlled in the Emergency Department and your examination reveals no active bleeding at this time.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately if you experience worsening bleeding, worsening or uncontrolled pain, difficulty breathing, or for any other concerning symptoms.
DCEye
You were evaluated in the Olive view-UCLA Emergency Department today for eye redness. Your [[PE (Physical Exam(ination))]] suggests _.
Call (818)-364-3538 to schedule an appointment with the eye specialist within one week for a repeat [[Eye Exam]]._
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience discharge from your eye, worsening eye redness, [[Eye Pain]], vision changes, headache, fever, vomiting, or any other concerning symptoms.
DCFall
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a mechanical fall. Your evaluation has revealed ___. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a fall before it gets better.
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco only as needed for severe pain. Do not drive or operate heavy machinery while taking norco.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.
DCFall
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a mechanical fall. Your evaluation has revealed ___. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a fall before it gets better.
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco only as needed for severe pain. Do not drive or operate heavy machinery while taking norco.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.
DCFall
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a mechanical fall. Your evaluation has revealed ___. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a fall before it gets better.
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco only as needed for severe pain. Do not drive or operate heavy machinery while taking norco.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.
DCFinger
You have been evaluated in the Olive View-UCLA Emergency Department today for finger pain. Your evaluation, including physical exam and x-ray, has revealed that you have a fracture of your _// no evidence of any acute fractures or dislocations_. Your finger was splinted in the Emergency Department_. Keep the splint clean and dry.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience any new or worsening finger pain, [[Numbness]], weakness, [[Discoloration]], fevers, or any other concerning symptoms.
DCFootPain
You have been evaluated in the Olive View-UCLA Emergency Department today for foot pain. The x-ray of your foot shows _.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your foot to control your pain.
Please follow up with your primary care physician within two days as needed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with a podiatrist in about 1 week. You can find an podiatrist by calling (818) 364-3676.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.
DCFracture
You have been evaluated in the Olive View-UCLA Emergency Department today for your injury while _. Your evaluation, including an x-ray of your _, have revealed a fracture of your _. Your __has been splinted in the ER.
Please rest, ice, and elevate your __to control pain and inflammation. Please take Tylenol of Motrin as needed for pain. Take vicodin for as needed for severe pain. Do not drive or operate heavy machinery while taking vicodin.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with an orthopedic surgeon in about 1 week. You can go to your primary care doctor or follow up with the referral we have given you. Please call (818) 364-3676 if you do not receive a call for your appointment time.
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.
DC[[Gallstone (Cholelithiasis)]]
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Abdominal Pain]]. Your evaluation suggests that your pain is due to [[Gallstone (Cholelithiasis)]]. It is not emergent at this time but it is recommended that you make an appointment at a surgery clinic to be evaluated to have your [[Gallbladder]] removed.
We will give you a referral to general surgery at olive view. They will call you with an appointment time in the future to discuss elective surgery. P lease call (818) 364-3129 if you do not receive an appointment date.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, fever, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], [[SOB (Shortness of Breath)]], or any other concerning symptoms.
DC[[Gastroenteritis]]
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to a viral gastroenterological infection which will improve on its own.
Remember to drink plenty of clear fluids at home and eat a bland diet.
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, recurrent vomiting, blood in your vomit, difficulty breathing, fevers 100.4°F or greater, or any other concerning symptoms.
You were evaluated in the Olive View-UCLA Emergency Department today for neck pain. Your _ suggests no acute abnormalities which require further intervention at this time.
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain.
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening neck pain, incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.
DC[[Gastroenteritis]]
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to a viral gastroenterological infection which will improve on its own.
Remember to drink plenty of clear fluids at home and eat a bland diet.
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, recurrent vomiting, blood in your vomit, difficulty breathing, fevers 100.4°F or greater, or any other concerning symptoms.
DC[[Gastroenteritis]]
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Nausea And Vomiting]]. Your evaluation suggests that your symptoms are most likely due to a viral gastroenterological infection which will improve on its own.
Remember to drink plenty of clear fluids at home and eat a bland diet.
Please follow up with your primary care physician within two days.If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, inability to tolerate fluids by mouth, recurrent vomiting, blood in your vomit, difficulty breathing, fevers 100.4°F or greater, or any other concerning symptoms.
DC[[Head Injury]]
You have been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your evaluation suggests _.
You will likely feel a little worse tomorrow due to the trauma please rest and control your pain by alternating Tylenol and Motrin every 4-6 hours as directed on the package. You should avoid contact sports, running, playing video games and studying for long periods of time.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience [[Severe Headache]], vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]], weakness, or any other concerning symptoms.
DCHeadache
You have been evaluated in the Olive View-UCLA Emergency Department today for headache. Your evaluation suggests _. Your pain improved with medication.
Please control your pain by alternating Tylenol and Motrin every 4-6 hours as directed on the package.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.
Return to the Emergency Department if you experience worsening or uncontrolled pain, vision changes, recurrent vomiting, difficulty with normal activities, abnormal behavior, difficulty walking, [[Numbness]]/tingling, weakness, or any other concerning symptoms.
DC[[Hemorrhoid (Pile)]]
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Hemorrhoid (Pile)]]. You were given a prescription for topical cream_ and stool softeners to help with your symptoms. Use a [[Sitz Bath]] and rest to help control your pain (instructions can be found at http://www.webmd.com/digestive-disorders/sitz-bath). Drink plenty of fluids.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, worsening bleeding in your stool, recurrent vomiting, blood in vomit, [[SOB (Shortness of Breath)]], fevers or any other concerning symptoms.
DCHernia
You have been evaluated in the Olive View-UCLA Emergency Department today for pain secondary to your hernia. Your evaluation suggests that you do not need any emergent surgery to repair your hernia today.
Please follow up with your primary care physician within the next week. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please arrange to see a general surgeon for elective surgery through your primary care doctor. If you do not have a primary care doctor, we will refer to surgery here, you will receive a phone call for an appointment time. If you do not get an appointment, you can call Outpatient Surgery Clinic, (818) 364-3129.
Return to the Emergency Department if you experience worsening pain, fever, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], [[SOB (Shortness of Breath)]], or any other concerning symptoms.
DCIngrownToenail
You have been evaluated in the Olive View-UCLA Emergency Department today for toe pain from an ingrown toe nail.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your foot to control your pain, as well as soak your foot in water 1-2 times daily and place an antibiotic ointment in the corner of your toenail and cover with a bandage.
Please follow up with a podiatrist to treat your ingrown toenail. You can call 818- 364- 3676 to find a podiatry appointment at Olive View-UCLA.
Return to the Emergency Department if you experience worsening pain, worsening swelling, fevers 100.4°F or greater, [[Numbness]]/tingling, change of color in your toes, or any other concerning symptoms.
DCKidneyStone
You have been evaluated in the Olive View-UCLA Emergency Department today for a [[Nephrolithiasis ((Kidney; Renal) Stone(s))]]. The stone will pass on its own and will be expelled in the urine. Please use the strainer as directed to strain your urine until your stone passes. Please read the information provided to you on discharge.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, fever, painful urination, [[Blood In Urine]], weakness, chest pain, difficulty breathing or any other concerning symptoms.
DCKneePain
You have been evaluated in the Olive View-UCLA Emergency Department today for knee pain. The x-ray of your knee shows_.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Please also rest, ice, and elevate your leg to control your pain.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, or any other concerning symptoms.
DCLaceration
You were evaluated in the Olive View-UCLA Emergency Department today for a laceration of your _. Your laceration was closed with sutures_ in the Emergency Department. Please keep the area surrounding the laceration clean and dry.
Please follow up with your primary care physician in 7-10 days to get your sutures removed. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience discharge from your laceration, redness around your laceration, warmth around your laceration, fever, vomiting, [[Numbness]], tingling, or any other concerning symptoms.
DCLegSwelling
You were evaluated in the UCLA Emergency Department today for leg swelling. Your [[PE (Physical Exam(ination))]] and _ reveal _.
Please rest and keep your leg elevated. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience [[SOB (Shortness of Breath)]], chest pain, palpitations, nausea/vomiting or any other concerning symptoms.
DCMVC
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation has revealed __. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco as needed for severe pain. Do not drive or operate heavy machinery while taking norco.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.
DCMVC
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation has revealed __. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco as needed for severe pain. Do not drive or operate heavy machinery while taking norco.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.
DCMVC
You have been evaluated in the Olive View-UCLA Emergency Department today for your injuries after a [[MVA; MVC (Motor Vehicle (Accident; Collision))]]. Your evaluation has revealed __. Please be aware that [[MSK (Musculoskeletal)]] pain commonly worsens a day or two after a collision before it gets better.
Please take Tylenol or Motrin as needed for pain using the directions on the box. Take norco as needed for severe pain. Do not drive or operate heavy machinery while taking norco.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, difficulty walking, [[Numbness]] or weakness in your arms or legs, chest pain, [[SOB (Shortness of Breath)]], confusion, vomiting, or for any other concerning symptoms.
DCMedRefill
You were evaluated in the Olive View-UCLA Emergency Department today for a medication refill.
It is very important that you establish primary care with a physician if you have not already done so to gain an optimal regimen for your medical conditions. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience chest pain, [[SOB (Shortness of Breath)]], [[Numbness]]/tingling, or any other concerning symptoms.
DCMedRefill
You were evaluated in the Olive View-UCLA Emergency Department today for a medication refill.
It is very important that you establish primary care with a physician if you have not already done so to gain an optimal regimen for your medical conditions. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience chest pain, [[SOB (Shortness of Breath)]], [[Numbness]]/tingling, or any other concerning symptoms.
DCMedRefill
You were evaluated in the Olive View-UCLA Emergency Department today for a medication refill.
It is very important that you establish primary care with a physician if you have not already done so to gain an optimal regimen for your medical conditions. Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience chest pain, [[SOB (Shortness of Breath)]], [[Numbness]]/tingling, or any other concerning symptoms.
DCMuscleStrain
You have been evaluated in the Olive View-UCLA Emergency Department today for your __ pain after _. Your pain is most likely muscle strain which will improve on its own.
Please rest, ice, and elevate your _to control pain and inflammation.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.
DCMuscleStrain
You have been evaluated in the Olive View-UCLA Emergency Department today for your __ pain after _. Your pain is most likely muscle strain which will improve on its own.
Please rest, ice, and elevate your _to control pain and inflammation.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.
DCMuscleStrain
You have been evaluated in the Olive View-UCLA Emergency Department today for your __ pain after _. Your pain is most likely muscle strain which will improve on its own.
Please rest, ice, and elevate your _to control pain and inflammation.
Please follow up with your primary care physician in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled pain, [[Numbness]] or weakness to your _, color change to your _, or for any other concerning symptoms.
DCNeck Pain
You were evaluated in the Olive View-UCLA Emergency Department today for neck pain. Your _ suggests no acute abnormalities which require further intervention at this time.
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain.
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening neck pain, incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.
DCNeck Pain
You were evaluated in the Olive View-UCLA Emergency Department today for neck pain. Your _ suggests no acute abnormalities which require further intervention at this time.
You should alternate Tylenol and Motrin every 4-6 hours to help control your pain.
Please follow up with your primary care physician within three days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening neck pain, incontinence, [[Numbness]]/tingling, weakness, or any other concerning symptoms.
DC[[Numbness]]
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Numbness]] in your _. Your evaluation, including labs and imaging_, suggests that your symptoms are due to __.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
DC[[Numbness]]
You have been evaluated in the Olive View-UCLA Emergency Department today for [[Numbness]] in your _. Your evaluation, including labs and imaging_, suggests that your symptoms are due to __.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can go to the finance/registration department or call (818) 364-1555 to find a primary care physician.
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
DCPEDSAbdominalPain
Your child has been evaluated in the Olive View-UCLA Emergency Department today. Their evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of the current condition.
Please follow up with your pediatrician within one to two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department immediately if your child has worsening [[Abdominal Pain]], persistent fevers of 100.4°F or greater, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], or any other concerning symptoms.
DCPEDSAbdominalPain
Your child has been evaluated in the Olive View-UCLA Emergency Department today. Their evaluation was not suggestive of any emergent condition requiring medical intervention at this time. However, some abdominal problems make take more time to appear. Therefore, it is important for you to watch for any new symptoms or worsening of the current condition.
Please follow up with your pediatrician within one to two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department immediately if your child has worsening [[Abdominal Pain]], persistent fevers of 100.4°F or greater, recurrent vomiting, blood in vomit, blood in stool, [[Melena (Dark Tarry Stool)]], or any other concerning symptoms.
DCPEDSFever
Your child was evaluated in the Olive View-UCLA Emergency Department today for a fever. Their evaluation suggests that the symptoms are likely due to a viral illness_. Viral illnesses should resolve on their own_.
Please alternate Tylenol and Motrin every 4-6 hours to help control fever and give plenty of fluids.
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department immediately if your child experiences persistent fevers greater than 100.4°F that cannot be controlled with Tylenol/Motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], difficulty breathing, or any other concerning symptoms.
DCPEDSFever
Your child was evaluated in the Olive View-UCLA Emergency Department today for a fever. Their evaluation suggests that the symptoms are likely due to a viral illness_. Viral illnesses should resolve on their own_.
Please alternate Tylenol and Motrin every 4-6 hours to help control fever and give plenty of fluids.
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department immediately if your child experiences persistent fevers greater than 100.4°F that cannot be controlled with Tylenol/Motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], difficulty breathing, or any other concerning symptoms.
DCPEDSHeadTrauma
Your child has been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your child’s evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your child was observed in the ED without any evidence of neurological instability.
Please follow up with your child’s pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences worsening headaches, vision changes, recurrent vomiting, difficulty with normal activities, [[Lethargy]], abnormal behavior, difficulty walking, weakness, persistent fevers, or any other concerning symptoms.
DCPEDSHeadTrauma
Your child has been evaluated in the Olive View-UCLA Emergency Department today for head trauma. Your child’s evaluation was not suggestive of any emergent condition requiring medical intervention at this time. Your child was observed in the ED without any evidence of neurological instability.
Please follow up with your child’s pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences worsening headaches, vision changes, recurrent vomiting, difficulty with normal activities, [[Lethargy]], abnormal behavior, difficulty walking, weakness, persistent fevers, or any other concerning symptoms.
DCPEDSLaceration
Your child was evaluated in the Olive View-UCLA Emergency Department today for a laceration. Their laceration was closed with sutures in the Emergency Department. Please keep the area surrounding the laceration clean and dry. To minimize scarring reduce sun exposure for the next year by wearing sunscreen, hats and long clothing.
Please follow up with your pediatrician within two days for a wound check. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences discharge from the laceration, redness around the laceration, warmth around the laceration, persistent fevers, recurrent vomiting, or any other concerning symptoms.
DCPEDSLaceration
Your child was evaluated in the Olive View-UCLA Emergency Department today for a laceration. Their laceration was closed with sutures in the Emergency Department. Please keep the area surrounding the laceration clean and dry. To minimize scarring reduce sun exposure for the next year by wearing sunscreen, hats and long clothing.
Please follow up with your pediatrician within two days for a wound check. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences discharge from the laceration, redness around the laceration, warmth around the laceration, persistent fevers, recurrent vomiting, or any other concerning symptoms.
DCPEDSOrtho
Your child has been evaluated in the Olive View-UCLA Emergency Department today for _ pain. Their evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable_.
Please rest, ice, and elevate to control pain and inflammation. Please give your child tylenol/motrin as directed in the attached dosing instructions for discomfort.
Please follow up with your Pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Please follow up with a pediatric orthopedic surgeon in about 1 week. You can find a pediatric by follow up with a pediatrician.
Return to the Emergency Department if your child experiences worsening pain, change of color in their _, persistent fevers, recurrent vomiting, or any other concerning symptoms.
DCPEDSOrtho
Your child has been evaluated in the Olive View-UCLA Emergency Department today for _ pain. Their evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable_.
Please rest, ice, and elevate to control pain and inflammation. Please give your child tylenol/motrin as directed in the attached dosing instructions for discomfort.
Please follow up with your Pediatrician within two days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Please follow up with a pediatric orthopedic surgeon in about 1 week. You can find a pediatric by follow up with a pediatrician.
Return to the Emergency Department if your child experiences worsening pain, change of color in their _, persistent fevers, recurrent vomiting, or any other concerning symptoms.
DCPEDSRash
Your child was evaluated in the Olive View-UCLA Emergency Department today for a rash. Their evaluation suggests _.
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences difficulty breathing or swallowing, lip/mouth/[[Tongue]] swelling, persistent fevers >100.4 that cannot be controlled with tylenol/motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], discharge from his rash, or any other concerning symptoms.
DCPEDSRash
Your child was evaluated in the Olive View-UCLA Emergency Department today for a rash. Their evaluation suggests _.
Please follow up with your pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if your child experiences difficulty breathing or swallowing, lip/mouth/[[Tongue]] swelling, persistent fevers >100.4 that cannot be controlled with tylenol/motrin, recurrent vomiting, [[Lethargy]], [[Seizure]], discharge from his rash, or any other concerning symptoms.
DCPEDSURI
Your child was evaluated in the Olive View-UCLA Emergency Department today for cough. Their [[PE (Physical Exam(ination))]] suggests that their symptoms are likely due to a viral illness. Viral illnesses should resolve on their own over time. You should give tylenol or motrin as needed using the directions provided to you and give plenty of fluids.
Please follow up with their pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if XXXX experiences worsening cough, trouble breathing, fever, recurrent vomiting, [[Lethargy]], or any other concerning symptoms.
DCPEDSURI
Your child was evaluated in the Olive View-UCLA Emergency Department today for cough. Their [[PE (Physical Exam(ination))]] suggests that their symptoms are likely due to a viral illness. Viral illnesses should resolve on their own over time. You should give tylenol or motrin as needed using the directions provided to you and give plenty of fluids.
Please follow up with their pediatrician within three days. If you do not have a Pediatrician, you can walk into the pediatric clinic on the scheduled clinic days to establish a doctor for you child. Please call (818) 364-3141 if you have any problems finding the clinic.
Return to the Emergency Department if XXXX experiences worsening cough, trouble breathing, fever, recurrent vomiting, [[Lethargy]], or any other concerning symptoms.
DCPalpitations
You have been evaluated in the Olive View-UCLA Emergency Department today for palpitations. Your evaluation suggests _.
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for persistent periods of very rapid heart rate that is associated with [[SOB (Shortness of Breath)]], worsening fatigue with trouble exercising, chest pain, [[Dizziness]], [[Fainting]], or for any other concerning symptoms.
DCPalpitations
You have been evaluated in the Olive View-UCLA Emergency Department today for palpitations. Your evaluation suggests _.
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for persistent periods of very rapid heart rate that is associated with [[SOB (Shortness of Breath)]], worsening fatigue with trouble exercising, chest pain, [[Dizziness]], [[Fainting]], or for any other concerning symptoms.
DCPenile
You were examined in the Olive View-UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that _.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with your primary care doctor for an appointment with a urologist. Call (818) 364-3129 if you were not given an appointment time over the phone with an Olive View-UCLA urologist.
Return to the Emergency Department immediately if you experience worsening penile pain, increasing redness or discharge from the penis, fevers or any other concerning symptoms.
DCPenile
You were examined in the Olive View-UCLA Emergency Department today for penile pain. Your [[PE (Physical Exam(ination))]] suggests that _.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with your primary care doctor for an appointment with a urologist. Call (818) 364-3129 if you were not given an appointment time over the phone with an Olive View-UCLA urologist.
Return to the Emergency Department immediately if you experience worsening penile pain, increasing redness or discharge from the penis, fevers or any other concerning symptoms.
DCPsych
You have been evaluated in the Olive View-UCLA Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff_ and have been cleared to go home.
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.
Psychiatric Urgent Care
14659 Olive View Dr.
Sylmar, CA 91342
(818) 485-0888
HRS M-F 8am-10pm Sat-Sun 9am-5:30pm
Return to the Emergency Department immediately if you experience thoughts of hurting yourself or others, audio or visual [[Hallucinations]], or for any other concerning symptoms.
DCPsych
You have been evaluated in the Olive View-UCLA Emergency Department today for your psychiatric complaint. You were evaluated by both [[Emergency Medicine]] and Psychiatry staff_ and have been cleared to go home.
Please follow up with your psychiatrist within 2-3 days. Please use the resources given to you in the Emergency Department.
Psychiatric Urgent Care
14659 Olive View Dr.
Sylmar, CA 91342
(818) 485-0888
HRS M-F 8am-10pm Sat-Sun 9am-5:30pm
Return to the Emergency Department immediately if you experience thoughts of hurting yourself or others, audio or visual [[Hallucinations]], or for any other concerning symptoms.
DC[[Pyelonephritis]]
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a kidney infection ([[Pyelonephritis]]). Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
DC[[Pyelonephritis]]
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a kidney infection ([[Pyelonephritis]]). Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
DCSOB
You were evaluated in the Olive View-UCLA Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Prednisone]]_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms
You have been evaluated in the Olive View UCLA Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable// reveal a shoulder dislocation_. We have reduced your shoulder, please use the sling for comfort_.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with an orthopedic surgeon in about 1 week with your primary care doctor. If you were referred to one from Olive View, please follow up with your scheduled appointment that you should receive a phone call for.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests__.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Genital Lesions]]_. Your [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] tests are still pending_; you have been given treatment for these infections presumptively _.
Please take your prescribed antibiotics for the full course of the medication as directed.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today after a syncopal episode. Your evaluation suggests that your symptoms are due to [[Vasovagal Syncope]]_. Your [[PE (Physical Exam(ination))]] was not suggestive of any emergent condition requiring medical intervention. Your EKG was normal_.
Please take tylenol or motrin as needed for pain using the directions on the box.
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.
You were examined in the Olive View-UCLA Emergency Department today for [[Testicular Pain]]. The [[US(G) (Ultra(sound; -sonogram; sonography))]] of your testicles did not show torsion_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Follow up with your primary doctor to make an appointment with a urologist or follow up with the referral given to you. You should receive a telephone call with an appointment time if you were referred to UCLA-Olive View
Return to the Emergency Department immediately if you experience worsening [[Testicular Pain]], penile pain, redness or discharge from your penis, fevers or any other concerning symptoms.
You have been evaluated in the Olive View UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]], cough, runny nose, fevers, and body aches. Your evaluation suggests that your symptoms are most likely to due a viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]] which will improve on its own.
Drink plenty of fluids at home. Take Tylenol/Motrin as needed using the directions on the box.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
You were evaluated in the Olive View-UCLA Emergency Department today for [[Urinary Retention]]. We have placed a [[Foley Catheter]]_. Keep the bag attached to your leg and empty when full. If you do not have any [[Urine Output]], or if the urine is cloudy or bloody, call your primary doctor or return to the ER.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
You were evaluated in the Olive View-UCLA Emergency Department today for problems urinating. Your urine suggests that you have a [[UTI (Urinary Tract Infection)]]_. Please drink plenty of clear liquids. You will be given a prescription for antibiotics, please take in full as directed_.
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
You were evaluated in the Olive View-UCLA Emergency Department today for [[Vaginal Bleeding]]. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] and labs show _.
Please follow up with your OB/GYN within two days. If you do not have an OB/GYN doctor, please arrange to see a specialist with your primary doctor or follow up with the referral with a Olive View-UCLA OB/GYN.
Return to the Emergency Department if you experience severe [[Abdominal Pain]], worsening [[Vaginal Bleeding]], [[Dizziness]], fevers, recurrent vomiting, or any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for a wound check. Your wound appears to be healing well; there is no evidence of infection_.
Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, spreading redness from your wound, pus from your wound, fevers 100.4° of greater, [[Numbness]]/tingling or weakness, or for any other concerning symptoms.
You have been evaluated in the Olive View-UCLA Emergency Department today for wrist pain. Your evaluation, including [[PE (Physical Exam(ination))]] and x-ray, has revealed that you have a fracture of your _ OR _ no evidence of any acute fractures or dislocations_.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.
Please also rest, ice, and elevate your arm to control pain and inflammation.
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with a hand surgeon within 1 week by calling (818) 364-3132.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms
DCSOB
You were evaluated in the Olive View-UCLA Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Prednisone]]_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms
DCSOB
You were evaluated in the Olive View-UCLA Emergency Department today for [[SOB (Shortness of Breath)]]. Your symptoms improved with Albuterol and [[Prednisone]]_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening [[SOB (Shortness of Breath)]], chest pain, palpitations, headache, light headedness, nausea/vomiting, or any other concerning symptoms
DCSTI
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Genital Lesions]]_. Your [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] tests are still pending_; you have been given treatment for these infections presumptively _.
Please take your prescribed antibiotics for the full course of the medication as directed.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.
DCSTI
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Genital Lesions]]_. Your [[Neisseria Gono((rrhea(e); cocc(us;al)))]] and [[Chlamydia(l)]] tests are still pending_; you have been given treatment for these infections presumptively _.
Please take your prescribed antibiotics for the full course of the medication as directed.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience fevers 100.4° or greater, worsening or uncontrolled pain, rashes, sores, vomiting, or for any other concerning symptoms.
DCSeizure
You have been evaluated in the Olive View-UCLA Emergency Department today for a seizure. Your evaluation, including labs and CT of your brain, were unremarkable_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Follow up with your primary care doctor to make an appointment with a neurologist. If you were referred to a neurologic here at Olive View-UCLA, please follow up with that appointment which you will be called for.
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
DCSeizure
You have been evaluated in the Olive View-UCLA Emergency Department today for a seizure. Your evaluation, including labs and CT of your brain, were unremarkable_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Follow up with your primary care doctor to make an appointment with a neurologist. If you were referred to a neurologic here at Olive View-UCLA, please follow up with that appointment which you will be called for.
Return to the Emergency Department if you experience recurrent [[Seizure]], difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
DCShoulderPain
You have been evaluated in the Olive View UCLA Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable// reveal a shoulder dislocation_. We have reduced your shoulder, please use the sling for comfort_.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with an orthopedic surgeon in about 1 week with your primary care doctor. If you were referred to one from Olive View, please follow up with your scheduled appointment that you should receive a phone call for.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.
DCShoulderPain
You have been evaluated in the Olive View UCLA Emergency Department today for [[Shoulder Pain]]. Your evaluation, including [[PE (Physical Exam(ination))]] and x-rays, were unremarkable// reveal a shoulder dislocation_. We have reduced your shoulder, please use the sling for comfort_.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain. Take norco as needed for severe pain. Do not drive or operate heavy machinery when taking norco_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with an orthopedic surgeon in about 1 week with your primary care doctor. If you were referred to one from Olive View, please follow up with your scheduled appointment that you should receive a phone call for.
Return to the Emergency Department if you experience worsening pain, [[Numbness]]/tingling, change of color in your arm, or any other concerning symptoms.
DCSoreThroat
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests__.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
DCSoreThroat
You have been evaluated in the Olive View-UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]]. Your evaluation suggests__.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
DCSyncope
You have been evaluated in the Olive View-UCLA Emergency Department today after a syncopal episode. Your evaluation suggests that your symptoms are due to [[Vasovagal Syncope]]_. Your [[PE (Physical Exam(ination))]] was not suggestive of any emergent condition requiring medical intervention. Your EKG was normal_.
Please take tylenol or motrin as needed for pain using the directions on the box.
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.
DCSyncope
You have been evaluated in the Olive View-UCLA Emergency Department today after a syncopal episode. Your evaluation suggests that your symptoms are due to [[Vasovagal Syncope]]_. Your [[PE (Physical Exam(ination))]] was not suggestive of any emergent condition requiring medical intervention. Your EKG was normal_.
Please take tylenol or motrin as needed for pain using the directions on the box.
Please follow up with your primary care doctor in 2-3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the ER immediately for worsening or uncontrolled symptoms, worsening headache, chest pain, [[SOB (Shortness of Breath)]], persistent vomiting, vision changes, recurrent [[Fainting]], or for any other concerning symptoms.
DCTesticularpain
You were examined in the Olive View-UCLA Emergency Department today for [[Testicular Pain]]. The [[US(G) (Ultra(sound; -sonogram; sonography))]] of your testicles did not show torsion_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Follow up with your primary doctor to make an appointment with a urologist or follow up with the referral given to you. You should receive a telephone call with an appointment time if you were referred to UCLA-Olive View
Return to the Emergency Department immediately if you experience worsening [[Testicular Pain]], penile pain, redness or discharge from your penis, fevers or any other concerning symptoms.
DCTesticularpain
You were examined in the Olive View-UCLA Emergency Department today for [[Testicular Pain]]. The [[US(G) (Ultra(sound; -sonogram; sonography))]] of your testicles did not show torsion_.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Follow up with your primary doctor to make an appointment with a urologist or follow up with the referral given to you. You should receive a telephone call with an appointment time if you were referred to UCLA-Olive View
Return to the Emergency Department immediately if you experience worsening [[Testicular Pain]], penile pain, redness or discharge from your penis, fevers or any other concerning symptoms.
DCURI
You have been evaluated in the Olive View UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]], cough, runny nose, fevers, and body aches. Your evaluation suggests that your symptoms are most likely to due a viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]] which will improve on its own.
Drink plenty of fluids at home. Take Tylenol/Motrin as needed using the directions on the box.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
DCURI
You have been evaluated in the Olive View UCLA Emergency Department today for your [[Sore Throat (Pharyngitis)]], cough, runny nose, fevers, and body aches. Your evaluation suggests that your symptoms are most likely to due a viral [[URI ([[URT (Upper Respiratory (Tract))]] Infection)]] which will improve on its own.
Drink plenty of fluids at home. Take Tylenol/Motrin as needed using the directions on the box.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Tongue]] swelling, difficulty swallowing, difficulty breathing, fevers 100.4°F or greater, recurrent vomiting, or any other concerning symptoms.
DCUrinaryRetention
You were evaluated in the Olive View-UCLA Emergency Department today for [[Urinary Retention]]. We have placed a foley catheter_. Keep the bag attached to your leg and empty when full. If you do not have any [[Urine Output]], or if the urine is cloudy or bloody, call your primary doctor or return to the ER.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
DCUrinaryRetention
You were evaluated in the Olive View-UCLA Emergency Department today for [[Urinary Retention]]. We have placed a foley catheter_. Keep the bag attached to your leg and empty when full. If you do not have any [[Urine Output]], or if the urine is cloudy or bloody, call your primary doctor or return to the ER.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening problems urinating, [[Back Pain (Dolor)]], blood in your urine, fevers, recurrent vomiting, or any other concerning symptoms.
DCVaginalBleed
You were evaluated in the Olive View-UCLA Emergency Department today for [[Vaginal Bleeding]]. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] and labs show _.
Please follow up with your OB/GYN within two days. If you do not have an OB/GYN doctor, please arrange to see a specialist with your primary doctor or follow up with the referral with a Olive View-UCLA OB/GYN.
Return to the Emergency Department if you experience severe [[Abdominal Pain]], worsening [[Vaginal Bleeding]], [[Dizziness]], fevers, recurrent vomiting, or any other concerning symptoms.
DCVaginalBleed
You were evaluated in the Olive View-UCLA Emergency Department today for [[Vaginal Bleeding]]. Your [[US(G) (Ultra(sound; -sonogram; sonography))]] and labs show _.
Please follow up with your OB/GYN within two days. If you do not have an OB/GYN doctor, please arrange to see a specialist with your primary doctor or follow up with the referral with a Olive View-UCLA OB/GYN.
Return to the Emergency Department if you experience severe [[Abdominal Pain]], worsening [[Vaginal Bleeding]], [[Dizziness]], fevers, recurrent vomiting, or any other concerning symptoms.
DCWeakness
You have been evaluated in the Olive View-UCLA Emergency Department today for general weakness. Your evaluation, including _, were within normal limits and not suggestive of any emergent condition requiring medical intervention at this time.
Please follow up with your primary care physician within two days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, difficulty walking or moving your arms or legs, [[Slurred Speech]], difficulty with normal activities, abnormal behavior, vision changes, or for any other concerning symptoms.
DCWoundcheck
You have been evaluated in the Olive View-UCLA Emergency Department today for a wound check. Your wound appears to be healing well; there is no evidence of infection_.
Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, spreading redness from your wound, pus from your wound, fevers 100.4° of greater, [[Numbness]]/tingling or weakness, or for any other concerning symptoms.
DCWoundcheck
You have been evaluated in the Olive View-UCLA Emergency Department today for a wound check. Your wound appears to be healing well; there is no evidence of infection_.
Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Return to the Emergency Department if you experience worsening or uncontrolled pain, spreading redness from your wound, pus from your wound, fevers 100.4° of greater, [[Numbness]]/tingling or weakness, or for any other concerning symptoms.
DCWrist Pain
You have been evaluated in the Olive View-UCLA Emergency Department today for wrist pain. Your evaluation, including physical exam and x-ray, has revealed that you have a fracture of your _ OR _ no evidence of any acute fractures or dislocations_.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.
Please also rest, ice, and elevate your arm to control pain and inflammation.
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with a hand surgeon within 1 week by calling (818) 364-3132.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms
Memory Tools
DCWrist Pain
You have been evaluated in the Olive View-UCLA Emergency Department today for wrist pain. Your evaluation, including physical exam and x-ray, has revealed that you have a fracture of your _ OR _ no evidence of any acute fractures or dislocations_.
You can alternate Tylenol and Motrin every 4-6 hours to help control your pain as directed on the package.
Please also rest, ice, and elevate your arm to control pain and inflammation.
Please follow up with your primary care physician within two days. Please follow up with your primary care physician in 3 days. If you do not have a primary doctor, you can call your insurance company to find one. If you do not have insurance, you can look for one on this of local clinics or go to the finance/registration department for more assistance.
Please follow up with a hand surgeon within 1 week by calling (818) 364-3132.
Return to the Emergency Department if you experience worsening or uncontrolled pain, [[Numbness]] or weakness to your hand, color change to your hand, or any other concerning symptoms
Memory Tools
Memory Tools
[[Exclusion Criteria]]
 Significant head trauma or prior stroke in previous 3 months
 Symptoms suggest [[SAH (Subarachnoid Hemorrhage)]]
 History of previous [[ICH (Intracranial Hemorrhage)]]
 Intracranial neoplasm, [[AVM (Arteriovenous Malformation)]], or [[Aneurysm]]
 Recent intracranial or intraspinal surgery
 [[Arterial Puncture]] at noncompressible site in previous 7 days
[[↑↑↑ [[BP (Blood P (Pressure))]] ↑↑↑]]
(systolic >185 mm Hg or diastolic >110 mm Hg)
 Active internal bleeding
 Blood glucose concentration <50mg/dl (2.7mmol/L)
 Acute bleeding diathesis, including but not limited to: Platelet count <100 000/mm³ (In patients without history of [[Thrombocytopenia]],
treatment with IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm³.)
 [[Heparin]] received within 48 hours, resulting in abnormally elevated [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]] greater than the upper limit of normal
 Current use of anticoagulant with INR >1.7 or PT >15 seconds (In patients without recent use of oral [[Anti(-)Coagulant(s)]] or [[Heparin]], treatment with
IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT
is abnormally elevated by local laboratory standards.)
 Current use of [[DTI (Direct Thrombin Inhibitor)]]s or direct [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] inhibitors with elevated sensitive laboratory tests (such as [[aPTT (Activated PTT (Partial Thromboplastin Time); 25s-35s)]], INR, platelet
count, and ECT; TT; or appropriate [[[[SPF (Factor (10; X); Stuart Prower Factor))]]a]] activity assays)
 CT demonstrates multilobar [[Infarction]] (hypodensity >1/3 cerebral hemisphere)
MDMPEPOccHealth
with occupational work exposure with relatively low risk of transmission. Extensive discussion with patient regarding risk of transmission in regards to [[HBV (Hepatitis B (Virus))]], C and HIV and relative rates given source patient and mechanism. [[Immunization]]s UTD as above, specifically [[TDaP (Tetanus (Tetany; Trismus; Lockjaw) (Toxoid) + (Reduced) Diphtheria (Toxoid) + Pertussis (Toxoid) Acellular Vaccine)]] and [[Hepatitis B Vaccination]]s. Discussed PEP at length with patients and after review of primary risks, benefits and alternative, given relatively low risk of transmission, mutual [[Decision Making]] to defer PEP at this time. Discussed prompt follow up with occupational health for bloodwork and serial serologies as needed.
NIH Stroke Scale
Interval: {NIHSS interval:17994}
Time: {Time; 0100-2400:14903} ***
Person Administering Scale: ***
1a. Level of consciousness:{exam; consciousness neuro:31423}
1b. LOC questions: (month; age) * 0 – answers both questions correctly * 1 – one question correctly *** 2 – neither question correctly
1c. LOC commands: [open/close eyes; grip/ release hand or other 1-step command]{Loc commands neuro:31401}
2. Best Gaze: [test horizontal only. Isolated peripheral [[CN 3 (Cranial Nerve (Three; III); Oculomotor)]],4,6 palsy =1]{exam; best gaze neuro:31402}
3. Visual: [upper & lower VF quadrants]{Visual neuro:31403}
4. [[Facial Palsy]]: [show teeth, raise eyebrows, close eyes]{Exam; neuro [[Facial Palsy]]:31404}
5a. Motor left arm: [extend arms]{Motor arm:27865}
5b. Motor right arm:{Motor arm:27865}
6a. Motor left leg: [hold 30 degrees supine]{Motor leg:27866}
6b. Motor right leg: [hold 30 degrees supine]{Motor leg:27866}
7. Limb Ataxia: [w/ eyes open. (B) Finger to nose; (B) heel to shin. ‘0’ if paralyzed or does not understand]{Limb ataxia neuro:31406}
8. Sensory: [to pinprick. If coma-> 2] {SENSORY:18028}
9. Best Language: [describe picture; name items in picture; read sentences]{exam; best language neuro:31408}
10. [[Dysarthria]]:[read or repeat words]{[[Dysarthria]] neuro:31409}
11. Extinction and Inattention: {findings; extinction neuro:31410}
Total: {0-42:17997}
Note:
A patient with a completely normal neurological exam and normal mental status
will have an NIHSS of 0. The maximum recordable [[NIHSS Score]] is 42. However,
since acute [[Ischemic Stroke]] causes unilateral paralysis and [[Blindness]], the maximum
score actually is 31 for a stroke patient with complete hemiparesis, [[Hemianopia]],
hemineglect, and aphasia.
Patients with an [[NIHSS Score]] greater than 15-20 are considered to have a severe
stroke clinically.
NYSDOH AI Recommendations (2014)
Indication: Percutaneous or [[Mucocutaneous]] exposure with blood or visibly [[Bloody Fluid]] or other potentially infectious material.
Tenofovir 300 mg PO daily + Emtricitabine 200 mg PO daily or [[Lamivudine (EPIVIR)]] 300 mg PO daily plus Either Raltegravir 400 mg PO twice daily or [[Dolutegravir (DOVATO)]] 50 mg PO daily
HIV Antibody Testing of Healthcare Worker
Baseline
4 weeks post-exposure
12 weeks post-exposure
When a potential [[Occupational Exposure]] to HIV occurs, every effort should be made to initiate PEP, as soon as possible, ideally within 2 hours. A first dose of PEP should be offered to the exposed worker while the evaluation is underway. In addition, PEP should not be delayed while awaiting information about the source or results of the exposed individual’s baseline HIV test.
Decisions regarding initiation of PEP beyond 36 hours post exposure should be made on a case-by-case basis with the understanding of diminished efficacy when timing of initiation is prolonged.
Relative [[Exclusion Criteria]]
Recent experience suggests that under some circumstances—with careful consideration and weighting of risk to benefit—patients may receive
fibrinolytic therapy despite 1 or more relative contraindications. Consider risk to benefit of IV [[(r)TPA(X) (Recombinant Tissue Plasminogen Activator; t-PA; Alteplase; CATHFLO; ACTIVASE®)]] administration carefully if any of these relative
contraindications are present:
 Only minor or rapidly improving stroke symptoms (clearing spontaneously)
 Seizure at onset with postictal residual neurological impairments
 Major surgery or serious trauma within previous 14 days
 Recent gastrointestinal or urinary tract [[Hemorrhage]] (within previous 21 days)
 Pregnancy
http://www.mdcalc.com/heart-score-for-major-cardiac-events/
Upon calculating the patient’s HEART score, they were found to have a score of 0-3, which indicates low risk, so the patient can be safely discharged with the understanding that they need to make an appointment with a primary care doctor to be referred for a stress test within the next 48-72 hours, or if they cannot arrange that they are to return to the ED, or sooner than that if they have any changing, persistent, or worsening symptoms.
In the studies referenced below, the patients in the low risk group were discharged and found to have a 0.9-1.7% change of having a major adverse cardiac event (defined as revascularization, [[MI (Myocardial Infarction)]], or all-cause mortality) within 6 weeks when studied both retrospectively and prospectively.
Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008 Jun;16(6):191-6. PMID: 18665203
Backus BE, et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013 Oct 3;168(3):2153-8. PMID: 23465250.
Resources
RESPsych
COMMUNITY PSYCHIATRY REFERRALS
Suicide Hotline: 877-727-4747 or 800-273-TALK (273-8255) or 888-628-9454 (Spanish)
Los Angeles County Psychiatric Emergency Team/PMRT:
310-618-9687 or 800-854-7771
LAPD SMART Team:
(213) 485-3300
Call your insurance for a list of psychiatrists and psychotherapists and outpatient programs.
Exodus Urgent Care Center:
Culver City: (310) 253-9494, 3828 Delmas Terrace, Culver City
Downtown Los Angeles: 323-276-6400, 1920 Marengo Street, Los Angeles
Fresno: 559-512-8335, 4411 East Kings Canyon Road
Open 24 hours per day, 365 days per year, on a walk-in basis
individuals in crisis can be assessed for stabilization services, medication refills/ evaluation and management, or hospitalization if necessary.
Los Angeles County Mental Health Clinics: must present to the clinic designated for service area. Call 24/7 Access Line: 1-800-854-7771 for clinic locations, hours, etc.
Antelope Valley: 661-723-4260, 349 East Avenue K-6, Lancaster 93535
Arcadia: 626-821-5858, 330 E. Live Oak Avenue, Arcadia 91006
Augustus Hawkins: 310-668-4271, 1720 E. 120th Street, Los Angeles, 90059
Compton: (310) 668-6800, 1600 E. Compton Blvd, Compton, CA 90220
Culver City: Didi Hirsch (310) 390-6612, 4760 Sepulveda Blvd.
Downtown: 213-430-6700, 529 Maple Avenue, Los Angeles 90013
Glendale: 818-244-7257, 1538 Colorado Blvd
Hollywood: (323) 769-6100, 1224 Vine Street, Los Angeles 90038
La Puente: 818-961-8971, 160 S. 7th St
Long Beach: (562) 599-9280, 1975 Long Beach Blvd., Long Beach 90806
North East: 323-478-8200, 5321 Via Marisol, Los Angeles, CA, 90042
Palmdale: 661-575-1800, 1529 E. Palmdale Blvd, Suite 150, Palmdale 93550
Rio Hondo: 562-402-0688, 17707 Studebaker Road, Cerritos 90703
San Fernando: 818-832-2400, 10605 Balboa Blvd, Suite 100, Granada Hills 91344
San Pedro: 310-519-6100, 150 West 7th Street, San Pedro, 90731
Santa Clarita: 661-288-4800, 23501 Cinema Drive, Valencia 91355
South Bay: 323-241-6730, 2311 W. El Segundo Boulevard, Hawthorne 90250
Sylmar: Hillview Mental Health Center (818) 896-1161 X211, 11500 Eldridge Ave.
West Central: 323-298-3680, 3751 Stocker Street, Los Angeles 90008
West LA: Edelman (310) 966-6500, 11080 West Olympic Boulevard, Los Angeles, CA 90064
West Valley: 818-598-6967, 7621 Canoga Avenue, Canoga Park 91304
Venice Family Clinic: (310) 392-8636
Walk-in appointments:
604 Rose Ave. 10-11:30 M, W-F or 2-3:30 M, T, F
2509 Pico Blvd. 10-11:30 M/F or 2-3:30 T, W, F
905 Venice Blvd. (teens only) 2-5 M-W
4700 Inglewood Blvd. Th 3:30-4:30
Other County Mental Health Clinics:
Orange County Mental Health: (714) 568-4463
Riverside County Mental Health: (909) 358-4705
San Bernadino County Mental Health (909) 387-7171
Santa Barbara County Mental Health (805) 681-5220
Tri-City Mental Health (909) 623-6131
Ventura County Mental Health (805) 652-6737
Los Angeles Gay & Lesbian Center
(323) 993-7500 1625 North Schrader Boulevard, Los Angeles
Counseling offered on a sliding fee scale basis. Support groups, HIV care, anger management, case management and other services also available.
HIV/AIDS Resources
APLA-AIDS Project Los Angeles- (213) 201-1388
AHF-AIDS Healthcare Foundation- (323) 860-5200
CHIRPLA-Housing- (213) 741-1951
Oasis Clinic-Medical Issues- (310) 668-5033
UCLA CARE Clinic-(310) 557-2273
Homeless Shelters (below are contact numbers to inform you of available local shelters)
Access Center 800-854-7771-will inform of available shelters in local areas
Cold Weather Shelters 800-548-6047
United Way 310-603-8962
Homeless Drop-In Centers:
OPCC Access Center: 1616 7th Street, Santa Monica (310) 450-4050
Drop-in center for clothing, showers, sack lunches, and referrals to shelters
St. Joseph’s Homeless Service Center 404 Lincoln Boulevard, Venice (310) 399-6878 x407
Emergency services, including shower, laundry, mail, clothing, counseling, and case management. All services provided free of charge. Orientation 8am M-F.
Step-Up on Second 2701 Ocean Park Boulevard, #150B Santa Monica (310) 392-9474
Psychotherapy, groups, case management, meals, drop-in center, and other services.
Homeless Health Care (HHCLA) 2330 Beverly Boulevard, Los Angeles, CA (213) 744-0724
Wide ranging outpatient services—therapy, psychiatry, groups, case management, referrals. All qualify for services.
Beyond Shelter 1200 Wilshire Boulevard, Los Angeles (213) 252-0772
Cornerstone 14000 Oxnard Street, Van Nuys (818) 901-4836
Walk-in drop-in center. Assistance with housing, groups, therapy, psychiatry. Meals
Long Beach Multi-Service Center
1301 W. 12th Street, Long Beach, (562) 733-1147
Outreach, case management and housing placement services. laundry, showers.
Domestic Violence Shelters
Domestic Violence Drop-In and Resource Center (310) 464-6281
Jewish Family Service DV Program (818) 505-0900, Los Angeles
Angel Step Inn (323) 780-7285, Los Angeles
STAR House (women and children) (323) 461-4118
Sojourn (310) 264-6644 X235, Los Angeles
1736 Family Crisis Center (213) 745-6434, Redondo Beach
Good Shepherd (323) 737-6111, Los Angeles
Haven Hills (818) 887-7481, Canoga Park
House of Ruth (909) 623-4364, Pomona
Valley Oasis (800) 945-6736, Antelope Valley
Financial Assistance:
L.A. County Department of Public Social Services (General Relief, CalWORKS, Medi-Cal etc.) (866) 613-3777
Local Office: 11110 W Pico Blvd, Los Angeles 866-613-3777
Medi-Cal (800) 541-5555
Social Security Administration (SSI, SDI, SSDI) – 24-hour Info Line (800) 772-1213
Local Office: 11500 W Olympic Blvd, Suite 300, Los Angeles 90064
Relative Risks
Estimated Per-Act Probability of Acquiring HIV From a Known HIV-Infected Source by Exposure Act
Type of Exposure Risk per 10,000 Exposures
Parenteral
Blood Transfusion 9,000
Percutaneous ([[Needle Stick]]) 30
Sexual
Receptive anal intercourse 138
Insertive anal intercourse 11
Receptive penile-vaginal intercourse 8
Insertive penile-vaginal intercourse 4
Receptive oral intercourse low
Insertive oral intercourse low
Other
Biting Negligible
Spitting Negligible
Throwing body fluids Negligible
(including semen or saliva)
http://www.cdc.gov/hiv/law/transmission.htm.
Factors that increase the risk of HIV transmission include early and late-stage [[HIV (Human Immunodeficiency Virus)]] and a high level of HIV in the blood. Factors that reduce the risk of HIV transmission include low level of HIV in the blood and the use of ART.
Rationale
Several clinical studies have demonstrated that HIV transmission can be significantly reduced by the post-exposure administration of [[Anti-Retroviral Therapy]] agents. A dramatic decline in [[Vertical Transmission]] was observed in the AIDS Clinical Trial Group (ACTG) 076 study,1 in which pregnant women and their newborns received monotherapy with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] ([[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]), and in the HIVNET 012 study,2 in which single-dose [[NVP (Nevirapine, VIRAMUNE)]] was compared with [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]]. A CDC retrospective [[Case Control]] study3 of [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]] use after occupational HIV exposure in healthcare workers (HCWs) showed an 81% reduction in risk of [[HIV (Human Immunodeficiency Virus)]] in persons who received [[Zidovudine; ((ZVD); (AZT); (Azidothymidine))]].
Because the ultimate goals of PEP are to maximally suppress any limited viral replication that may occur and to shift the biologic advantage to the host cellular immune system to prevent or abort early infection, the Committee recommends the use of a three-drug PEP regimen for all significant risk exposures.

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