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, adrenal crisis, hyperthyroidism, or sepsis. Doubt antibiotic associated diarrhea.
Plan: PO rehydration, reassess, discharge with OTC antidiarrheal meds//short course antibiotics
You have been evaluated in the Emergency Department today for your rectal pain. Your evaluation has revealed that your symptoms are due to hemorrhoids. You can apply hemorrhoid cream, which is available over the counter, and do sitz baths to soothe the area. Stay well hydrated, eat a high fiber diet, 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 shortness of breath, have headache, feel weak, have fever, or for any other concerning symptoms.
Thank you for choosing us for your care.
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.
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.
You were evaluated in the Emergency Department today for epigastric 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 shortness of breath, worsening or uncontrolled abdominal or chest pain, headache, light headedness, feeling faint, nausea, vomiting, bloody vomit or stools, black tarry stools, or any other concerning symptoms.
Thank you for choosing us for your care.
This patient with *** presents with symptoms concerning for acute, upper GI bleed, likely secondary to ***.
Differential diagnoses includes peptic ulcer disease (PUD = most common) versus less likely gastritis versus Mallory-Weiss tear versus AVM. Presentation not consistent with esophageal or gastric variceal bleeding or Boerhaave’s syndrome. Presentation not consistent with other etiologies upper GI bleeding at this time. No red flag features or high risk bleeding. No evidence of hemorrhagic shock. Glasgow-Blatchford 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 or antibiotics given low likelihood of variceal bleeding from portal hypertension and cirrhosis.*** No indication for abdominal imaging at this time.
Plan: labs, LFTs, close hemodynamic monitoring, serial reassessment, PPI therapy, Octrotide/CTX***
This patient has a presentation consistent with rectal bleeding, most likely due to ***. Differential diagnosis includes ***. Low suspicion for hemorrhoids (external or internal, including thrombosed hemorrhoids), rectal ulcer (HIV, syphilis, STI) or rectal foreign body. Presentation not consistent with other acute, emergent causes of upper or lower GI 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
This patient presents with symptoms concerning for a lower GI bleed. Differential diagnoses include diverticulitis (most common cause) versus hemorrhoids. Less likely etiologies include angiodysplasia, cancer, IBD. Presentation not consistent with mesenteric ischemia 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***
This patient presents with *** nausea, vomiting & diarrhea. Differential diagnoses includes possible acute gastroenteritis. Abdominal exam without peritoneal signs. Currently ***euvolemic 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
This patient presents with abdominal pain, most consistent with acute, uncomplicated biliary colic. Bedside ultrasound demonstrating visible gallstones 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 to evaluate gallbladder pathology.***
Plan: labs, LFTs, lipase, RUQ U/S***, pain control, supportive care, serial reassessment
EM DOT PHRASES 