low risk

Chest Pain – Low Risk (Trop Out)

MDM

This patient presents with chest pain, with symptoms suggestive of noncardiac chest pain. History without high risk features (e.g., not substernal, no exertional component, not relieved with rest, *** ).

Minimal CAD risk factors (including age), recent negative stress test (<2 years).*** Exam without evidence of volume overload. EKG without signs of active ischemia. HEART score: ***. Given the timing of pain to ER presentation, plan to send single troponin // delta troponin to evaluate for NSTEMI.*** Presentation not consistent with acute PE (Wells low risk *** // PERC negative***), pneumothorax, thoracic arotic dissection, cardiac effusion or tamponade.

Plan: labs, troponin***, EKG, CXR, ASA***, pain control, serial reassessment

UTI – Low Risk

MDM

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 kidney stone or infected stone. ***ICON negative; not consistent with pregnancy, including ectopic. No indication for labs or imaging at this time.

Plan: UA, UCx, antibiotics***

ALLERGIC RASH – Low Risk

MDM

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 hypotension 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 blockers, steroids. No indication for epinephrine at this time.*** Given lack of respiratory symptoms, no indication for EpiPen Rx.***

Plan: ***H1/H2 blockers, steroids, close hemodynamic monitoring, serial reassessment

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 alcohol withdrawal 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

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

HEADACHE – Low Risk, Pregnancy

MDM

This patient presents with a headache most consistent with ***. Differential diagnosis includes migraine versus tension type headache. No headache red flags. Neurologic exam without evidence of meningismus, focal neurologic findings. Presentation not consistent with acute intracranial bleed to include SAH (lack of risk factors, headache history). Presentation not consistent with acute CNS infection to include meningitis or brain abscess, Temporal arteritis unlikely, as is acute angle closure glaucoma given history and physical findings. Presentation not consistent with other acute, emergent causes of headache at this time. Plan to treat symptomatically with pain medication. No indication for imaging/LP at this time.***

Plan: pain medication, CT brain***, serial reassessment

HEADACHE IN PREGNANCY

This pregnant patient presents with headache of rapid onset. Etiology is unclear but includes possible preeclampsia, HELLP, SAH or other ICH. Considered, but think unlikely, CVT, Waterman’s syndrome, carotid dissection. Plan to work up with basic labs, UA to screen for proteinuria, consider head CT, pain control, reassess.

HYPERGLYCEMIA – Lo Risk

MDM

This patient is a @AGE@ @SEX@, presenting with apparent acute hyperglycemia. Differential diagnosis includes ***. Considered DKA versus HHS, 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 hyperglycemia. Plan to treatment supportively. No indication for further workup at this time.

Plan: supportive care, serial POC glucose monitoring, labs***, serial reassessment

Rectal Bleed – Low Risk

MDM

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

Gastroenteritis – Low Risk

MDM

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