This is a fictitious patient seen at a fictitious hospital called Janus General. Don’t believe me? I’m on staff there – see
The Case…
It’s 4 AM and the ER is starting to be an even split between etoh intox, fast track’ers (5 weeks of leg dizziness?), and the usual sick folks, when you get your next patient – a 23 year old female BIBA for ams.
You go see the patient. She is sleeping, but easily arousable. She responds to you questions with mostly actual words, but the words don’t make any sense together. Also, she seems to be making up words. Regardless of the lack of meaning to her prose, she is speaking volubly and fluidly. With the history lacking, you move onto the physical exam.
VS wnl
PE benign except neuro exam is limited as patient does not follow instructions. PERRL, moving all four extremities, no obvious facial droop, EOMI.
No EMS note. No accompanying family. No previous visits documented in the EMR. The only phone number in the chart is to the patient’s cell phone in her pocket.
While during an actual shift you might think the etiology of her AMS is etoh, this is a case of the month. It can’t be that easy.
1. Please provide a complete differential including your top diagnosis.
2. Please describe what work-up you would do for this patient in the ED including treatment/dispo plan for your top diagnosis.
andygrock
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