Your first day as a doctor

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Reply 200

electricjon

Original post by thegodofgod

What's her weight and BMI?

She weighs 115kg, giving her a BMI of 36.

Reply 201

Dekota-XS

Original post by electricjon

You x-ray her left shoulder. It's normal. On returning from x-ray she seems a bit more comfortable, but still refuses to move both arms because of the pain.

Her left ankle now really hurts.

Administer cortisone and anti-inflammatories and see if it makes a difference.

Reply 202

Subcutaneous

This Is gonna sound silly but..ECG?

I don't think it's an MI, although I've seen them with normal obs...and shoulder pain can be one of those obscure areas where it can radiate. Although im still saying psych referral for munchausens, ECG was a more 'clutching at straws' suggestion.

Although by now I suspect she'll be starting to get on my nerves so anywhere but a&e may be a good idea...

(edited 13 years ago)

Reply 203

electricjon

Original post by Subcutaneous

Exactly, although seems to obvious as she's fitting the bill textbook style...but this isnt real so yeah I'd pop my dollar on that.

Sounds like she just needs a cup of tea and a heart to heart- maybe go through her social history? Abuse etc.

You talk to the parents. She comes from a good and loving family and, apart from the shoulder problems, has no other history.

Her ankle really hurts now. She says she twisted it as her right shoulder popped out the first time. She thinks it might be broken, and wants you to x-ray it.

Reply 204

electricjon

Original post by Subcutaneous

This Is gonna sound silly but..ECG?

Normal sinus rhythm.

Reply 205

electricjon

Original post by Dekota-XS

Administer cortisone and anti-inflammatories and see if it makes a difference.

You give her 200mg hydrocortisone and 75mg diclofenac IV. Nothing happens.

Morphine

Original post by c0nfus3d

Morphine

You give her more morphine. It doesn't settle her, though she is starting to get a bit drowsy...

Reply 208

Subcutaneous

Original post by electricjon

Normal sinus rhythm.

Psych referral...maybe to a ward if still pain unmanaged and get a referral done on ward to pain team lol

Reply 209

electricjon

Original post by Subcutaneous

Although im still saying psych referral for munchausens

You offer her a psychiatry referral. She says "How dare you! You think I'm mad? My f**king shoulders and ankle are broken. Sort it out or I'm going to make a formal complaint and have you struck off for negligence."

She starts crying.

Reply 210

Dekota-XS

Hold on, if she was having a meal prior to the pain than the pain could have been induced by changes in blood glucose levels. Run endocrinological tests.

Reply 211

Tech

Original post by electricjon

ask her what the doctors did in the hospital where she attended before? and also ask her if her ankle was hurting at all when she first came in or if it only just started that second..?

Reply 212

Dekota-XS

Anyhow, first x-ray her ankle!

Reply 213

Subcutaneous

Original post by electricjon

You give her more morphine. It doesn't settle her, though she is starting to get a bit drowsy...

Oh that's just what you need..maybe let her sleep. I was going to wildly suggest an anesthetist comes to see and ?PCA but no, not if getting drowsy.

Reply 214

electricjon

Original post by Dekota-XS

Anyhow, first x-ray her ankle!

You x-ray her left ankle. It's normal. On returning from x-ray she remembers that she gets left from right confused sometimes. It's actually her right foot that she thinks is broken. Then again, it might just be lymphoma from all these x-rays.

Reply 215

electricjon

Original post by Tech

ask her what the doctors did in the hospital where she attended before? and also ask her if her ankle was hurting at all when she first came in or if it only just started that second..?

You ring up the hospital where she attended before. They dig out the case notes and x-rays, all of which fail to confirm that she ever suffered a single dislocated shoulder. The receptionist says "Oh yeah I remember this girl - she was a nightmare!"

Reply 216

thegodofgod

Original post by electricjon

An EEG if she's confused? :confused:

Reply 217

No Future

Original post by electricjon

Her vitals are normal, and was having dinner just before her shoulder popped out. She is not thirsty. She is screaming in pain, saying her left shoulder is dislocated. She says that she knows her own body, and that this has happened a million times before, and she just wants you to fix it.