Post Conference Letter, 1/28/09
Dr. Zane’s wonderful lecture is now online, for those of you who missed it or want a refresher on surge capacity in disaster settings.
Thanks also to Dr. Constantine for his wonderful M+M presentation yesterday. The following M+M tips are adapted from Dr. Strayer’s followup email:
Key teaching points from this case of infective endocarditis:
* Do not convey undue diagnostic certainty to patients. In patients without definitive evidence of a specific diagnosis, consider that their symptoms, instead of reflecting a benign disease, could be the early symptoms of a more serious disease that hasn’t declared itself yet, and advise accordingly.
* Be careful about assigning specific diagnoses when lack of definitive evidence of these diagnoses exists. Gastritis, gastroenteritis, reflux, dyspepsia, heartburn, constipation, costochondritis, migraine, influenza, muscle spasm, sprain, strain, and anxiety are examples of diagnoses that should be assigned cautiously. Symptom-based diagnoses such as chest pain, abdominal pain, headache, cough, and knee pain, while less satisfying to patients, usually better reflect the degree of diagnostic certainty we are able to generate in an emergency visit.
* Unless a patient is discharged without a period of observation or diagnostic studies, the chart should include a follow-up note, documenting the evolution of care and justifying discharge.
* Abnormal vital signs should either be normalized, explained, or a plan for addressing them included in the chart.
* Infective endocarditis may present with a variety of signs and symptoms. Consider the diagnosis in patients who have risk factors (intravenous drug use, abnormal heart valves) or suggestive findings (prolonged course of fevers and malaise, new murmur).
Posted
on Thursday, January 29th, 2009 at 6:31 am by Nick. Filed under
Post-Conference Letter, Infectious Disease, Blog.
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