PDx and focus of care
Good afternoon,
I have a conundrum that I need input on so I can try and delicately convey the concept of PDx to a physician. Please take a look at these scenarios and reply with what would be the PDx. Any thoughts on timing of symptoms or diagnosis would also be appreciated, as well as any good advice on how to explain this. As it stands, the physician believes that the diagnosis that was the focus of care is PDx, regardless of what the patient was admitted for.
Scenario 1: Pt comes to ED for hematemesis. Physician notes admission for GI bleed. An admission EKG is done and is evident pt is having an MI. No indications prior to EKG that patient is having an MI (no chest pain, abnormal labs, etc). During admission, focus of care is the MI. No further work up or symptoms of GI bleeding during admission.
Scenario 2: Pt comes to ED for hematemesis. Physician notes admission for GI bleed. EKG done after admission and is evident pt is having an MI. No indications prior to admission that patient is having an MI (no chest pain, abnormal labs, etc). Focus of care is the MI. No further work up or symptoms of GI bleeding during admission.
Scenario 3: Same as scenario 1, but pt complains of chest pain in ED.
Scenario 4: Same as scenario 2, but pt complains of chest pain in ED.
Thank you in advance,
Laura Hoot
Comments
Was the MI due to Anemia tachycardia? Type 2? was "no further work up of bleed/hematemesis due to instability? on anticoags? It's kind of odd to throw up blood and then think it doesn't matter. We know nothing is impossible, but trying to imagine the scenario. so if the MI were Type 2 the hematemesis GI bleed would make sense to me regardless of EKG timing.
If the MI is not a Type 2 and is due to coronary plaques, was the hematemesis just incidental to retching? was there a comorbid cause of the blood that only was seen because of the N/V due to NSTEMI 1/STEMI? like bleeding ulcer, esophagitis, or varices?
LONG gone case but. if in doubt - "please clarify suspected cause of hematemesis?"
I'd also look at ED time vs IP time. Lately I see 12-36 hours in presentation vs IP admit time. That period of time that they are trying to decide if it's an IP.
if the GIB was NO issue that quickly and there wasn't an MI. would they have been obs?