wtf?...gout!?

[talentdeficit]

el d,

is the guy you know who got gout the barback at dna? because i had the exact same conversation with some friends while in sf a few weeks ago. we concluded it was a skin infection based on our shoddy knowledge of pirate novels.

[hobbes9324]

OK, I suppose - my prejudice would be that an ER MD would be more familiar with acute problems, but as long as he/she was boarded, and hopefully has a few years of experience you're likely fine.

I'd stick with my previous recommendations, though....

MM MD

[Victor]

hobbes, thanks for the responses. i certainly plan to go back after a few days if the pain does not subside.

[RiverTheNuts]

ISS GOOT!!!!

[tolbiny]

Now that Victor's gout has subsided i feel that i can come clean and divulge the enjoyment i get out of asking him "Hows da gout?" every morning.

[Skipbidder]

[ QUOTE ]
OK, I suppose - my prejudice would be that an ER MD would be more familiar with acute problems, MM MD

[/ QUOTE ]

Wow, an ER doc thinks an ER doc would be the best to make the diagnosis. [img]/images/graemlins/smile.gif[/img]

It's pretty unfair to judge internists by the performance of doc-in-the-boxes. It would be like me making broad generalizations about ER docs based on the performance of MY hospital's ER docs.

I just had a patient in the ICU. Elderly diabetic woman with new acute onset shortness of breath. They gave her Lasix and sent her up to the ICU on full face mask ventilation. No EKG. No cardiac enzymes. Next day, she is in cath lab for her flash pulmonary edema secondary to acute myocardial infarction. In the next room down in the unit, they had a young woman with intentional overdose (reportedly benzos-- not my patient) and respiratory depression. They sent her up to the floor without giving her flumazenil and without even getting a Utox. [img]/images/graemlins/smile.gif[/img] Excellent patient care.

[Victor]

so the doc gave me colchicine and indomethacin. in 3 days i went from not being able to walk to nearly pain free and even played a soccer game. its been 5 days now and there is no pain at all but the toe is still quite swollen to look at. regardless, i am glad the pain passed so fast and i can play sports and run again.

beer would really taste good right now tho.

[hobbes9324]

Wellll....the point was supposed to be that an ER doc is likely more comfortable diagnosing acute gout, which this didn't sound like, as opposed to an FP/IM just out of training.

I also (completely wrongly) assume that the ER doc is a boarded, residency trained guy....and I know I have a skewed perception.

I see patients mismanaged all the time, by specialists of all stripes....including my specialty.

And lastly, flumazanil is NOT indicate in benzo overdose, unless you're certain the patient hasn't been on them chronically, which I'm sure you know. I DO agree that they should have gotten a tox screen.....

If there were no missing details in your elderly ladies story, I'd avoid your ER, or fire the MD who was on.

MM MD

[Victor]

so it turns out i didnt/dont have gout. from the blood test the day after the initial pain i did not have elevated uric acid levels which means NO GOUT. also, i did not have elevated white blood cell count which means there was no sign of infection. strange. the doc had no real explanation. possibly a skin infection, he didnt know.

oh well, its gone and i can walk and run again so im happy. i can also drink beer again.

[WackityWhiz]

YAY!!! Glad to hear the good news man!