Oligoanalgesia

A CASE: A 40 y/o black homeless man presents with difficulty walking secondary to extreme left lower extremity pain. On exam, the patient is afebrile, HR 105, RR 20, BP 120/65. His extremity is swollen, warm, erythematous and extremely tender to touch. A sepsis code is called; the patient is Read more…

You think you know asthma?

A 25 y/o smoker presents to the ED with SOB and tells you her asthma is acting up. You think to yourself, “I love the crashing asthma patient!” Within 5 minutes bipap is bedside, solumedrol is given and somehow she’s already on her 3rd round of combinebs. “Nailed it!”

She’s feeling pretty good now and breathing better. The room’s starting to get chaotic, but you’re a good doctor so you make sure to write her scripts for a course of oral corticosteroids and you even remember to say, “see your doctor in the next week” as she signs the discharge papers. Job well done!… right?

There are soooooooo many things missing here it hurts. Sure the course of steroids will cool everything off for a few more days, but what about a week from now when she’s back chain-smoking with her buds? Does she have albuterol at home? Is she going to see her PMD? Does she have a PMD??? Well you can ask her in 2 weeks when she comes back. (Catch my point?)

Controller versus Rescue medications (more…)