ED Consults Pathology on Acute Abdomen Just to “Make Them Aware”

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SANTE FE, NM – Emergency Medicine attending physician, Dr. Edith Lin, believes in a proactive and multidisciplinary approach to patient management.  When a 46-year-old woman with sixteen hours of sharp right upper quadrant abdominal pain, anorexia, fever, and emesis presented to her Emergency Department last Thursday evening, she sprang into action.

I'll just page overhead for the entire hospital to be ready for a patient
I’ll just page overhead for the entire hospital to be ready for a patient

“I thought, whoa doggie!  We got a hot one!” Dr. Lin enthused.  “I tapped on that abdomen and ping!  Rebound tenderness like you”d never believe!  I knew something was in there that needed to come out!”

“I decided to order my standard workup.  The paradigm of Emergency Medicine is to cast a wide net and see what swims in, after all.  So the usual imaging and blood work for a possible acute abdomen: HIDA scan, basic labs like vitamin D levels and lupus anticoagulant, maybe 72 hours’ worth of troponins, and a transvaginal ultrasound to rule out an ectopic pregnancy.  Although Radiology always stonewalls me on that last one, since of course it requires they come out of their little coffee-soaked cave.  Something about the probe not fitting through the urethral meatus. Anyway…”

Dr. Lin continued, “The workup I outlined above is a pretty standard ED approach.  What makes me different is the collaborative, interdepartmental nature of the care of my patients.  We, in the ED, are always telling ourselves how great it would be if we got a little more time – 30 min to prepare for that multi-car MVA or gangland shooting spree instead of 30 seconds.  I feel it’s empathic 21st-century medicine to extend the same courtesy to my colleagues.”

“So I called General Surgery to let them know about a possible chole.  Once some data started coming back it was just as I expected – the patient’s vitamin D levels were shockingly low, so I ordered some stat PO repletion with a large meal washed down with a generous carton of chocolate milk for extra calcium – I thought the surgical resident would appreciate me taking care of that for him before he made it down.  Then I thought about some of the complications of surgery, and called Hepatobiliary just in case there was an anatomic misadventure in the biliary tree, and Vascular in case an errant trocar punched through some valuable real estate, and Plastics for the inevitable poor wound healing.  You know, just to make them aware.”

“Many people in my shoes would call it a night at that point, but not Edith Xiaofan Lin, no sir-ee.  My last call of the night was to Pathology, just to load the boat with consults.  I mean, there’s going to be a specimen at some point one way or the other, and they need to be ready.”

Dr. Lin appeared to have more to say on the topic, but at that moment a new patient popped up onto the board.  “A neonate with respiratory distress!” she exclaimed.  “Better let Adolescent Medicine know!  After all, he’ll be coming to them some day!”

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