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    (Original post by thegodofgod)
    What's her weight and BMI?
    She weighs 115kg, giving her a BMI of 36.
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    (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.
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    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...
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    (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.
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    (Original post by Subcutaneous)
    This Is gonna sound silly but..ECG?
    Normal sinus rhythm.
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    (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.
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    Morphine
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    (Original post by c0nfus3d)
    Morphine
    You give her more morphine. It doesn't settle her, though she is starting to get a bit drowsy...
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    (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
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    (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.
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    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.
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    (Original post by electricjon)
    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..?
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    Anyhow, first x-ray her ankle!
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    (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.
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    (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.
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    (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!"
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    (Original post by electricjon)
    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.
    An EEG if she's confused? :confused:
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    (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.
    Ask her what the doctors normally do to fix it?
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    (Original post by electricjon)
    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.
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    (Original post by Subcutaneous)
    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.
    She's drowsy but she's still screaming in pain. The morphine soon wears off and she is fully alert again.
 
 
 
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