Articles by Teresa Wu, MD & Brady Pregerson, MD
Patient states she was feeling fine until around 10pm when she suddenly
developed abdominal pain and “bloating”. She describes the pain as
generalized, but mentions that it feels more severe around the edges of
her abdomen, in the suprapubic area, and at both costal margins. The
upper abdominal pain is most severe in the midline and is worse when she
breathes in or presses on it.
“Are you sure I don’t need that magic stroke medication that I saw on
TV?” you hear a patient ask through the curtains in your acute care
area. “I am within the 3-hour window.” You pause to listen to your
senior resident reassure the patient that she is not having a stroke and
explain to her the risks and benefits of that “magic stroke
“You need to have a rectal exam” you explain to one of your patients.
He’s a 47-year-old with chronic back pain who is in the ED for an
exacerbation of his pain accompanied by many of the associated
accoutrements, such as sciatica, numbness and trouble urinating.
“Do you know the four A’s of being a great emergency physician?” a
colleague asks. He just overheard you giving your “It’s a virus” lecture
to a twenty-something with a bad URI and no PMD to call her in a
useless prescription for Fogmentin or Maxiﬂoxicin.
“Hey, save some pizza for me!” your resident exclaims as he joins the
masses indulging in a late night treat from the ED administration. Over
the past few months, the department’s “door-to-doc” times and
“length-of-stay” times have improved enough to warrant a pizza party for
The labs have all come back on a 38-year-old female who you suspected
had pyelonephritis. She had presented with 24 hours of flank pain and
fever but no vomiting, abdominal pain or dysuria. Her last menstrual
period was 2 weeks ago and she denies any possibility of pregnancy.
Your last patient of the evening is a 42-year-old veterinarian who
recently returned from a trip to Mexico where he injured the dorsum of
his right hand on a cactus spine. He states that he was able to remove
the entire spine and the site subsequently became infected.
You breathe a small sigh of relief when your senior resident begins
presenting his next case to you. The patient is a 17-year-old G1P0 who
found out she was pregnant via a home pregnancy test last month. She presents to the ED
at 6 AM because she has been vomiting all night and can’t sleep.
You are about to start your shift after a somewhat lengthy department
meeting where one of the main topics discussed was utilization review
with a special emphasis on cutting down the number of unnecessary
advanced imaging studies. The physician champion for cutting down on
unnecessary imaging had a lot of valid points.
“We have 6 traumas coming our way, Doc. ETA is 15 minutes. We’ve
mobilized backup. The ultrasound machines are in the rooms, and the
residents are gowned and ready to roll. Is there anything else you need
help preparing?” You give your favorite charge nurse a thankful smile
and start preparing yourself for the organized chaos that is about to
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