Wednesday, January 27, 2010

Old man to Emerg

A man in their 70s comes to emerg yesturday with a vague complaint of slight weakness. Hasn't felt well lately. No chest pain, no diaphoresis, no SOB, no.. anything, except a bit of leg weakness.

Also doesn't have a family doctor, and hasn't been to one in over 15 years.

First thing I think of is that this guy could be a ticking time bomb. Weakness could be anything from cardiovascular, to endocrine, to neuro, to ... well... anything! Especially if he hasn't been routinely checked for CAD, pulmonary, diabetes, cholesterol, etc.

Well his vitals weren't bad P 105, R-18, BP 150/100, SpO2 98 T 36. I could see that perhaps he had longstanding hypertension with his pulse being tachy and his pressure being what it was. The guy wasn't on beta-blockers or any form of hypertension meds... something he would most likely need.

Well we did a bunch of tests, including an ECG and things were ok. Then we repeated his ecg. Ooops! ecg changes? Shit. We hook him up to the monitor and things get wacked out from there.

I'm wondering if he had a primary care physician, would he be in this same situation? Perhaps, but probably not. He has most likely sustained a high BP for a while, which increased his risk for cardiovascular compromise.

Canadians have a good thing going with their coverage, but definately they are lacking in primary care. Even I don't have a family doc right now. Mine left primary care to do work claim forms and direct consumer billing for minor plastic surgery.

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