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.
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...
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.
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."
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.
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.
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 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.
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!"
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.
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.
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.
Haha
Running any further tests won't help but get some immunological blood tests going for the sake of it.