In deference to Beenben - ask hobbes a medical question - Page 8

Baxter · #71 03-25-2006, 04:26 AM

Possible poor circulation or don't worry about it?

Baxter · #72 03-25-2006, 04:40 AM

I have a question on how you think during an evaluation.
Your patient is a 65 year old male who was at a basketball game when his grandson got injured. He became very anxious and hyperventilated. He comes into the emergency room complaining of light-headedness and paresthesias in his hands and around his lips.

How do you deal with the information here? Do you think:
1) His symptoms are caused by a decrease of Paco2 and an increase in ph in the blood. In order to return him to normal I need to have him breathe into a paper bag and let him know the status of his grandson.
or 2) The treatment for hyperventilation is to have the patient breathe into a paper bag. This is what I have done in the past and is the procedure recommended in the literature.

I hope the question is clear enough about your thought process in typical and emergency situations.

hobbes9324 · #73 03-25-2006, 04:49 AM

Perioral tingling is, as far as I know, always due to hyperventilation - and you will very seldom get a doc to say always about anything.
We've been going with a touch of ativan as an anxietolytic, as there are some theoretical concerns about the old paper bag trick, although it's been used forever.
In passing, I'm not worried about a stroke - the bilateral symptoms make it pretty unlikely, without visual complaints being a part of the picture....

MM MD

Baxter · #74 03-25-2006, 05:12 AM

You missed the whole question. I'm not concerned about how to treat the guy, I want to know how you approach treating the guy. Read it again.

molokoman · #75 03-25-2006, 05:19 AM

If you had gonnorhea would it be blatantly apparant?

Utah · #76 03-25-2006, 05:30 AM

[ QUOTE ]
A good primary care physician could add exponentially more years of life by keeping patients out of the ICU, yet they don't get reimbursed very well for so called well-patient visits.

[/ QUOTE ]One of the big issues is the reimburse schemas for well-patient visits for doctors.

However, the problem is much bigger. We really dont know how to do preventitive care or to get consumers to follow a healthy plan. I worked on one of the biggest care management programs (diabetes, CHF, etc.) in the country constituting 10s of millions of consumers. The founding principle of these programs was to reduce healthcare costs by being proactive - i.e. preventitive care. The dirty secret was that the care management programs had almost zero effect on the well being of consumers and at BEST had a 2% success rate.

hobbes9324 · #77 03-25-2006, 05:54 AM

I guess I'm missing the point, likely because I'm tired (miserable shift)
If you're able to reassure the gentleman about his grandsons conditon, most likely the paper bag isn't needed.

If you can't, I'd use ativan instead. (Say that the grandson is badly injured - while knowing may be better than not knowing, he still may hyperventilate)

As per my original post, I'm not much of a paper bag guy....

hobbes9324 · #78 03-25-2006, 05:58 AM

If I did?

Christ, I hope so.

But that's not what you're asking.

In males, it's very uncommon for it to be symptom free - unlike trichamonas or chlamydia.

Women, as we know, are mysterious - and are much more likely to be asymptomatic, or nearly so.

After all, it ain't called "the drip" for nothing....

MM MD - over and out, and not dripping, for the night.

Mitch Evans · #79 03-25-2006, 07:34 AM

Doctors of osteopathic medicine are students who couldn't get into an MD school- true or false?

posnera · #80 03-25-2006, 11:59 AM

[ QUOTE ]
[ QUOTE ]
A good primary care physician could add exponentially more years of life by keeping patients out of the ICU, yet they don't get reimbursed very well for so called well-patient visits.

[/ QUOTE ]One of the big issues is the reimburse schemas for well-patient visits for doctors.

However, the problem is much bigger. We really dont know how to do preventitive care or to get consumers to follow a healthy plan. I worked on one of the biggest care management programs (diabetes, CHF, etc.) in the country constituting 10s of millions of consumers. The founding principle of these programs was to reduce healthcare costs by being proactive - i.e. preventitive care. The dirty secret was that the care management programs had almost zero effect on the well being of consumers and at BEST had a 2% success rate.

[/ QUOTE ]

This is undoubtedly true. The real "dirty little secret" of medicine is this:

It is your life and your health. A good doctor can help, but in the end it is your problem. My wife is an endocrinologist. If you have diabetes, she can teach you how to manage your diet, lifestyle and medications to keep your blood sugars under control. This will prevent early heart disease, stroke, renal failure, blindness, erectile dysfunction and a whole host of other costly problems. If you don't/can't follow the plan, there is nothing she can do and it is only a matter of time before I'm taking expensive care of your complications in the ICU. Where is the failure in the system? It's your life, take some personal responsibility for it.