Observation Status In The Ed's Syndrome

Scenario: An elderly woman showed symptoms of near syncope and was admitted via ambulance to a small community hospital. She experienced an inability to move on her own and almost lost consciousness while watching her grandson play basketball. Her symptoms occurred during a visit to her daughter’s home, which is approximately 150 miles from Liza’s home. When Liza was admitted to the hospital, her daughter explained the numerous types and dosages of medications her mother was taking. She also mentioned that Liza had not been taking her Coumadin as directed by her physician for the past week or so. Liza was admitted to the intensive care unit for evaluation. Over the course of hospitalization, Liza’s condition worsened.

This case involves Mr. Horton, his wife, and his mother in law. While Mr. Horton was a patient at Niagara fall memorial medical center the nurses noted in his medical records that he was dizzy, confused and unable to focus. Horton was in a two story private room with a window

My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to

Her drug screen showed positive benzodiazepines and blood alcohol was negative. Troponins were negative. Also, her initial work up showed acute kidney injury with a creatinine of 1.84, and potassium of 5.8. Her chest x-ray showed small amount of infiltrate in the right lower lobe. The CT scan of the head did not show any acute changes. The abdominal CT scan showed constipation and 6 mm opacity in her bladder. She had an electroencephalogram (EEG) which revealed diffuse generalized nonspecific encephalopathy. In addition, there was slowing of the left hemisphere consistent with left intracerebral lesion. The assessment diagnoses were acute respiratory failure (ABG of 87.287, pCO2 of 45.2, pO2 of 380 and biacarbonate of 20 on vent settings), altered mental status, attempted suicide, infectious process, medication use, hyperglycemic nonketotic, and less likely cerebrovascular accident given that her CT scan of the head was normal. She was admitted to the Intensive Care Unit under the care of Dr. Modupe Kehinde. She was intubated for airway protection and remained intubated until 5/23/2016 (7 days). She was on ventilator and was given nutritional support

Pt is seen in the ER room and states that he is tired and had tremors so he came to the ER to be on the safe side. Daughter also states that he had tremors in the morning and. Patient's CC is that was tired and had tremors in the morning. States that he stays alone, was worried, and has no past history. Assessment of the head shows no sign of deformities or trauma. Neck shows no sign of deformities or trauma. Chest shows no sign of

The spouse explained to us that up to two day ago, that patient was able to sit in a wheelchair, ate pureed foods and was awake and alert. What was presented the day in the ER was a patient with multiple fractures, nonverbal and very lethargic. The husband was not aware of any falls, or medical conditions that would cause her symptoms. He also chose not to follow up with exams looking for a reason, such as a stroke. We accepted his wishes and returned his wife back to the nursing home with no treatment. The decision was made as a team effort between the spouse, medical staff, and the patient, with her advance directives.

Patient 1: monitor B/P, pulse, respirations, skin appearance and touch, notable changes in neurologic function, ECG, lab

-Contacted Desert Springs facility and follow-up on the patient. Spoke to medtech Muriel and stated that another caregiver has been going to patient’s room and no complaint or concern was raised from the patient. Instructed Muriel to see the patient and she stated that patient is the same and “normal” sitting up in her recliner’s chair. Speech is clear and no facial droop per Muriel. Per Muriel, patient did complaint about a week ago with right foot

At today’s visit she is found in her room at Tiffany hall SNF. She is awake, alert and confuse. The facility staff reports that the patient often refused care. She is wheelchair dependent. She is assist with most ADLS. She has chronic edema in lower extremities and refuses to elevate legs. She also refused

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

The patient is an 88-year-old gentleman who is brought to St. Joe's ER complaining of inability to walk. The patient 6 days ago began to having trouble walking with his walker. He reported left arm pain which radiated up his left arm. The patient had pain in the left foot. The patient was taken to St. Joseph's Hospital in Wayne. In the ER he was diagnosed with gout and begun on Colchicine. Since that time he has shown no improvement. He has become essentially chair-bound and unable to walk so he is brought to St. Joe's ER. His medical history is significant for atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease and the patient also has a colostomy bag he had a procedure done and they were unable to connect is

The patient is 66 year-old male who is brought to St. Joe's ER by BLS after being found with altered mental status at home. The patient reports he used heroin 2 days prior to admission. The patient was found by his brother hallucinatin with bladder or bowel incontinence the morning of presentation. The patient has not eating in approximately 4 days. The patient himself denies having any complaints, but he is a very poor historian. His medical history is significant for prior heroin and cocaine abuse, alcohol abuse of unknown duration, hypertension, cirrhotic liver, he has had an anterior cervical discectomy of C5-C7 with anterior compression in May of 2012 and a closed reduction of C6-C7 billateral dislocation , cholecystectomy in the

Independent and out of bed as tolerated, the client was ambulating well. J.S. was considered a fall risk because of her decreased level of consciousness upon arrival to the unit and possibility of decreased blood

The member is a 64-year-old male who was arrived to the emergency room via emergency medical services and later admitted to Maui Memorial Hospital 03/15/2016 after awakening around 10 pm with left-sided weakness and a left facial droop. The member has a history of atrial fibrillation for which he takes Pradaxa. The member was transferred to United Hospital, St. Paul on 03/20/2016 via air ambulance where he was hospitalized for 16 days before being discharged to an acute rehabilitation hospital on 04/05/2016.

The patient is a 95-year-old female who is brought to the emergency room because of a fall at home and episodes of spacing out and staring. Her past medical history is absolutely negative for any previous and the patient is on no medications. There is a discrepancy in the history between what is described by the daughters, as well as what is documented in the ED records. and there is a question of did this patient have a seizure episode and fall or and did she simply loose her balance and fall. The patient herself was quite clear about her fall and does not have any recollection of any any other abnormal events. She sustained a fracture of the right superior and inferior pubic rami. She was markedly anemic with a hemoglobin of 7.1, which