A 17 year old patient comes in by ambulance for chest pain and tachycardia. His heart rate was in the 130s. He was hypertensive. He was sweating. He had a history of ADHD and was on Adderall. No other medications. No alcohol or drugs.
His exam was unimpressive and all the testing came back negative, but the patient still remained tachycardic. So we gave him a couple doses of Ativan, thinking he may have taken a little too much Adderall. Still no better. Then we started doing some additional tests to rule out the less common reasons for his symptoms. D-dimer normal. He denied alcohol or drugs, but we checked for them anyway. Tox screen normal. TSH normal.
His heart rate remained in the 140s and he was still hypertensive on re-evaluation. So the on-call doctor gets called for admission. He wants a cardiology consult. No problem.
The cardiologist recommended labetolol. Sounded like a little overkill, but we went with his recommendations.
So the patient gets started on a labetalol drip and we place the admit orders.
We go back to the room and inform the family of the discussions we had with the other doctors. The dad is not pleased.
Could this be due to him smoking that fake marijuana crap?”
“He told me he doesn’t use drugs.”
“Yeah, well he’s a f***ing little liar. He smokes it all the time. Probably smoked a bowl right before we got here.”
The patient shrugged his shoulders.
“K2 really isn’t really a ‘drug’ because they sell it over the counter … right?”
“Ummm … no. Not really.”
It’s sad that your parents are going to be stuck with a large bill for all the tests we did so that you could argue semantics.
This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.