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Showing posts from January, 2014

General Medicine: Swapping Zebras For Horses

Doreen is an 81-year-old lady referred to general medicine by the emergency department. She doesn't have a black and white diagnosis like 'right lower lobe pneumonia'. Our patients rarely do. She does have a cough, and a history of chronic obstructive pulmonary disease, but her chest X-Ray is non-specific and the respiratory team don't feel she is unwell enough for non-invasive ventilation or admission under their team.
Likewise, the cardiology team were unexcited by a mild troponin rise but agree she has an element of heart failure.
She is certainly in renal failure, but nephrology weren't even consulted because it's clear a moderate creatinine rise isn't her main issue.

Doreen, like many general medicine patients, has a little bit of everything. A mild of an exacerbation of her COPD, a bit of heart failure, and acute on chronic renal failure. She has a touch of diabetes, hypertension & cholesterol, pretty severe osteoarthritis and is falling more in t…