🚀 go-pugleaf

Hello..

Nospam*ckrin@Iamerica.net (Charles S. Krin, DO FAAFP) wrote:

>Question 1: What further information do you want to try to obtain on
>the history?

Medications, how long homeless, how long has he been drinking and when
was his last drink?  Any drug abuse? Last bowel movement and color,
color of urine.  Any splenomegaly or scleral icterus?  Any night
sweats?  Does patient have contact with any relatives and if so, can
they furnish better/more info or offer help?

>Question 2: How much can you depend on any history he gives you that
>is not previously documented? (by the same token, how much can you
>depend on the old documentation obtained from the patient which is not
>backed up by family or professional observations?)

Take it with a grain of salt.

>Question 3: What is your working assessment, and what do you want to
>do while waiting for the doc to arrive and re evaluate the patient?

ALD and ascites, possible TB.  Start nasal O2, restrict salt and fluid
intake.  Counsel patient to get help to quit drinking.  Monitor for
signs of withdrawal. 

>Question 4: What lab work or tests would you want to have ready to
>roll by the time the doc gets there?

SMAC20, H&H, LFTs,  Albumin, Bili, Sputum Culture for AFB, EtOH level.

>(BTW, this is NOT a live case, but a montage of several that I have
>attended over the last ten years. Will try to keep track of all
>replies to the groups, and feed appropriate info back. Again, NO EMAIL
>responses will be answered! This is to prevent dumping critical
>information to only one part of the audience.)

-Mike-