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Neurology Avoids Disaster Admission, Admits to Medicine

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HAMPTON, CA – Kaiser Health Hospital had a close call this Wednesday.  Thanks to the diligent efforts of Dr. Trevenstein, a neurology attending at Mercy hospital, a patient was appropriately admitted to the hospitalist service, narrowly avoiding being on a highly-specialized neurology service.

I would love to consult, but this stroke seizure Parkinson's ALS patient doesn't quite fit the neurology picture
I would love to consult, but this stroke seizure Parkinson’s ALS patient doesn’t quite fit the neurology picture

Mrs. Negevny, a community living 73-year old, was evaluated in the ED with progressive left upper extremity weakness and slurred speech.  After the EM resident activated the stroke team based on the chief complaint, Mrs. Negevny was evaluated by Dr. Trevenstein and hospitalist Dr. Singh as part of the stroke protocol.  After determining that the symptoms have been ongoing for 2-3 weeks, Dr. Trevenstein dropped a quick consult in the chart and headed back to the office, entrusting the care to Dr. Singh.  A subsequent phone interchange was captured on tape:

Dr. Singh: I’m calling about that stroke code in the ED.  Just want to make sure you will be taking her on your service.

Dr. Trevenstein: Yeah, but she was way past the TpA window, so there is not much for us to do.  Admit her to medicine… Put her on telemetry… MRI/MRA carotid dopplers, statins… you know all the good stuff.  We’ll consult.

Dr. Singh: Right, but this is a pure neurology case, I think that the patient would be better off with you.

Dr. Trevenstein (after diligently checking the lab results): Let me look at her labs.  She has some WBCs in her urine… So it’s a UTI, so admit to medicine.  We’ll consult.

Dr. Singh: You know I’m looking through her chart, and she also has Parkinson’s.

Dr. Trevenstein: Yeah, but we really cant admit a patient to neurology who has an active UTI and is possibly septic.  We’ll follow along.

Dr. Singh: You know, I’m looking around a bit more and she also has multiple sclerosis… on betaseron and Tysabri.

Dr. Trevenstein: Yeah… but you know… UTI.  I have not idea how to deal with this.  I just looked at her labs again and she has 4+ epithelial cells in the her urine.  How the hell did those get there?  Sounds bad.

Dr. Singh (as he flipped through the chart some more): She had PRES (posterior reversible encephalopathy syndrome, a rare and puzzling swelling of the brain) in the past.

Dr. Trevenstein: UTI.  Is no joke in my book…

Dr. Singh (interrupting): Oh wow!  Carries a history of ALS!

Dr. Trevenstein: UTI… Do you treat that with antibiotics, still?  Have they made any new ones since penicillin?  I’d hate to play around with those drugs.  But we’ll definitely consult.

Dr. Singh: You know, she was seen for generalized tonic-clonic seizures in your clinic just last week.

Dr. Trevenstein: After you treat the UTI, get an EEG, MRA/MRI.  I’ll even talk to the tech for you.  We’ll make it happen before Friday.  Admit to medicine.

Dr. Singh: She’s having an active seizure right now!!  4 of Ativan IV stat!!!

Dr. Trevenstein: She is also having an active UTI.

Dr. Singh: Huntingtons!

Dr. Trevenstein: I’ll have to get our resident on this consult.  May be an interesting case.

Dr. Singh: Devics (extremely rare disease where body attacks nerve fibers involved with visions)!

Dr. Trevenstein: UTI.

Dr. Singh: Myasthenia gravis.

Dr. Trevenstein: UTI.

Dr. Singh: Guillain-Barre.

Dr. Trevenstein: That’s not a real diagnosis. It’s now called AIP (acute idiopathic polyradiculoneuritis).

Dr. Singh: Chiary Malformation, Meigs Syndrome, MELAS, Kluver-Bucy syndrome.

Dr. Trevenstein: UTI, UTI, UTI and I’m pretty sure you made that last one up.  Admit to medicine.

Dr. Singh: You will consult?

Dr. Trevenstein, (Doing everything he can to assure his colleague): I will send the resident in the morning.

At this point Dr. Singh called the admitting medicine resident to initiate admission.  When asked about the “quick story” on the patient, he blurred out “UTI.”

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  • Show Comments

  • Avatar
    Varun Malyala

    Neurology..all talk, no show

  • Avatar
    Jennifer Blase

    LOL Maysun Ali, Aparna Sarma, Manan Shah, Lindsey Frischmann

  • Avatar
    Jyotsna Mareedu

    Lol!! Got to share this one with my fellow hospitalists today

  • Avatar
    Elizabeth Macri

    Yup- that’s the way it is and I’m good with that.

  • Avatar
    Zori Stoilova

    Hey hey hey!!!

  • Avatar
    Yunus Ahmadi

    Anh!

  • Avatar
    Audrey Maminta

    How would you know?

  • Avatar
    Joshua Berg

    I blame Hopkins modules personally.

  • Avatar
    Andrew Karl Terry

    Wait, there are places where neurology actually admits patients primarily?!?!?

  • Avatar
    Rebecca Bakkestuen

    Dianne Radcliffe

  • Avatar
    Jennifer Meyer

    As a hospitalist nurse…..this is my life more days than not.

  • Avatar
    Jennifer Meyer

    As a hospitalist nurse…..this is my life more days than not.

  • Avatar
    LeeAnn Hemmingson Sievers

    Sad but true! Hilarious.

  • Avatar
    LeeAnn Hemmingson Sievers

    Sad but true! Hilarious.

  • Avatar
    Andrea Moore

    Kim

  • Avatar
    Julia L Mikell

    Love it!!

  • Avatar
    Ramesh Cherukuri

    This is hilarious and true

  • Avatar
    Amy Lysy

    Just substitute “pregnant” for “UTI”…

  • Avatar
    Heather LaClair

    Hahaha. Hilarious! Story of our life

  • Avatar
    Kristy Kmit Hagen

    So darn true ☺

  • Avatar
    Paul Matera

    Yes but at the point of ridged abdomen 102T 21000wbc it really doesnt matter what is causing it … Time to cut

  • Avatar
    Matthew T. Eaton

    Gotta make sure to consult medicine for all surgery admits. Somebody has to continue the home meds.

  • Avatar
    Thomas Kreibich

    I definately remember some of this happening during residency. Usually this was sorted out by the residents so we tried to be fair and make sure patient’s with a primary neurologic illness were on our service. Very funny post though, beware the UTI :)

  • Avatar
    Thomas Kreibich

    I definately remember some of this happening during residency. Usually this was sorted out by the residents so we tried to be fair and make sure patient’s with a primary neurologic illness were on our service. Very funny post though, beware the UTI :)

  • Avatar
    Kara Menahem

    Rofl!

  • Avatar
    Kara Menahem

    Rofl!

  • Avatar
    Tracy Robinson Luster

    This is hilarious and so true. I don’t miss it!

  • Avatar
    Noah Gudel

    Jerk. :-)

  • Avatar
    Jody Madden

    OD’d on onions!

  • Avatar
    Jody Madden

    Add ortho consult, too. She could have fractured something falling during her seizure.

  • Avatar
    Sarpoma Sefa-Boakye

    Why not consult Urology also and ID? She might have ESBL and might need an indefinite foley…residents to be sent for consult lol let’s get everyone on board lol

  • Avatar
    Doug Kwazneski II

    The stock photo guy’s grin is so perfect for this headline.

  • Avatar
    Dana Reddy

    Lindsay Pagano is this you?

  • Avatar
    Rita Conway Seymour

    Love this, it’s a medical “Onion”. Attn Mary Frances Mccarthy

  • Avatar
    Rana Whitney

    Lol

  • Avatar
    Tara Marie

    Eileen Magnuski do Neuro docs do this? Haha

  • Avatar
    Karen Ressler Levinson

    I really needed another “laugh out loud” GomerBlog this morning. Thanks.

  • Avatar
    Vulihn Ta

    Actually, GYN should have been consulted. The patient was a woman after all! Hahaha

  • Avatar
    Aislinn Black

    One and only time I’ve ever seen hypokalemic periodic paralysis (in a healthy young guy) was as an intern in the MICU. When he was ready to be downgraded to the floor, we tried to send him to neuro. They felt medicine was more appropriate because the patient had an episode of diarrhea.

  • Avatar
    Desiree Dwyer Spellings

    Lol too funny Amy Hale

  • Avatar
    Crystal Perry

    God, that’s funny.

  • Avatar
    Jessika Stahl

    Works this way as a geriatric nurse, too. It never matters what s/sx my pt has, the hospital always sends them back saying “it’s just a UTI”. Very frustrating!

  • Avatar
    Lenny Powell

    Truth

  • Avatar
    Tammy Dais Gallagher

    Kristy Kmit Hagen

  • Avatar
    Belinda Smith

    Raechal Stoops I think this is how Frankston works

  • Avatar
    Ana Negron

    This is so true that its (almost) not funny

  • Avatar
    Jessica DeBoer Hafner

    Katie Simmons Heather LaClair

  • Avatar
    Linda Paray

    Anna Sorokin , this hits too close to home !!

  • Avatar
    Gomerblog

    Funny, we are working on an article about a medical student diagnosing a heavy metal disorder on a patient with an acute appy

  • Avatar
    Jennifer Wooten

    Julia L Mikell

  • Avatar
    Grace Lee Henninger

    Ain’t THAT the truth

  • Avatar
    Steve Zanoni

    Christi Ward, Grace Lee Henninger, Im sure you have never seen anything like this. Ever.

  • Avatar
    Brian Burns

    Sad but true ……

  • Avatar
    Chananya Goldman

    LMAO. Classic.

  • Avatar
    Paul Matera

    That was hysterical and unfortunately true had many of those exchanges with neuro and surgery and ENT. I had one surgery resident ask for the selenium level before he sees the patient (obvious acute appy) just admitted to medical with a surgery consult

  • Avatar
    Emma Costello

    Craig. ROFL.

  • Avatar
    Ronda Harper

    Uti, uti, uti! I lolled.

  • Avatar
    Emma Morrissey

    Alex Pace

  • Avatar
    Audrey Maminta

    Residency woes? This is the current state of Hospitalist medicine!!

  • Avatar
    Jon Longoria

    Lol! Residency woes :

  • Avatar
    Osama Zahriya

    Aisha Siddiqi

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