I am certainly enjoying the debate that Rowley's
'innocuous' case has generated.
Ingredients in the pot:
a) The woman's history is certainly very likely to be
anginal but the new onset is a bit
concerning....although our GP colleagues see these
pateints all the time and don't 'necessarily' send
them in.
b) She has a risk of an acute coronary syndrome ...it
probably sits at around 0-5%
c) The blood tests and ECG done at this stage do not
help us. A normal 12hrly troponin would minimise that
risk and she could then be discharged with appropriate
therapy and early follow up by cardiology/physician
with an interest. In some units this is carried out by
A&E on a Clinical Decision Unit, in others by
admitting under medicine.
d) Public expectations have risen. Telling her its
angina (probably true) and sending her home
immediately may not appease her or her family if they
are made aware of the risks.
e) If she was your mother or the local cardiologist's
mother...she probably would have got what Sam Waddy
originally suggested...high quality care.
10 years ago I would have done (d) ....now I am
practising (c).....if it was my mother I would want
her to be taken care of by Dr Waddy.
Taj
=====
Dr Taj Hassan
Consultant in A&E Medicine
Dept of A&E Medicine
Leeds General Infirmary
Leeds LS1 3EX, UK
Work email: [log in to unmask]
Tel : (0113) 392 6470 Fax : (0113) 392 2810
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