low risk

Gallstones – Low Risk

MDM

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

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 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 infection, vertebral basilar artery insufficiency, cerebellar hemorrhage or infarction, intracranial mass or bleed, temporal lobe epilepsy, multiple sclerosis, trauma, complex migraine headache. Other acute, emergent causes of vertigo are unlikely given at this time. No indication for head imaging at this time.

Plan: meclizine, supportive care, serial reassessment

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, asthma, postnasal discharge, medication side effect, CHF, lung cancer or mass).

Plan: ***CXR, supportive care, reassess

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, antipsychotics, anticholinergics, antacids, or antihistamines. Presentation not consistent with acute anorectal disorders. Low suspicion for chronic causes of constipation including hypothyroidism or electrolyte disorders. Presentation not consistent with other acute, emergent causes of constipation at this time.

Plan: supportive care, Rx ***, XR abdomen***, electrolytes***

Back Pain – Low Risk

MDM

This patient presents with back pain most consistent with ***. Differential diagnoses includes lumbago versus musculoskeletal spasm / strain versus sciatica.*** No back pain red flags on history or physical. Presentation not consistent with malignancy (lack of history of malignancy, lack of B symptoms), fracture (no trauma, no bony tenderness to palpation), cauda equina (no bowel or urinary incontinence/retention, no saddle anesthesia, no distal weakness), AAA, viscus perforation , pulmonary embolism, 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