0*Please note, this content is prior to peer review, should not be used clinically, and can only be used for educational purposes in conjunction with a definitive source.MSE Chief Complaint:w/ pertinent PMH/PSH ofp/wVital sign and exam abnormalities (pertinent to chief compliant):Ddx includes but not limited to:Suspicion forPlan:Chief Complaint:chest painp/w chest painp/wAbbreviated HPIOnsetQualityCardiac risk factorsHTNHLDtobobesityDMCADPacemaker Exam:NAD, no obvious remarkable cardio-pulmonary findingsDdx includes but not limited to acute cardio-pulmonary processesConcern forPlanDiagnostically:upregEKG/trop/CXR/cbc/bmpBNP given may assist with challenging diagnostic dilemma on CHF (appreciation of limited utility)Therapeutically:ASANitro deferred given unknown if contra-indication in inferior STEMI. Per discretion of accepting team after EKG.RUQ/epigastric painp/w RUQ painp/w epigastric pain HPI (limited 2/2 to triage setting)hx of gallstonesunknown hx of gallstonesProvocationworse with eatingnot worse with eatingEmesisNo emesisNauseaFeversheavy etoh useNSAID useExam (limited 2/2 to triage setting)NADModerate distressRUQ TTP+ Murphy’s signNeg Murphy’s signTTP in epigastrumAbd benignNo flank pain.DDx includes but not limited to hepato-biliary pathology, gastric pathology. Less likely renal patholgy PlanDiagnostically:upregEKG (while not highest on ddx, given possible anginal equivalent)Trop (while not highest on ddx, given possible anginal equivalent)ASALabs:cbc, bmp, LFTs, lipaseUAImaging:RUQ per discretion of accepting team and formal v. bedside ED US per discretion of accepting team to maximize expeditious care.RUQ (Formal ordered given suspicion bedside US will not suffice and attempt maximize expeditious care).Therapeutically:ZofranNorcoTylenolPt deferred pain medsshortness of breathp/w SOBp/wHPI (limited by triage setting)onsetknown respiratory pre-existing pathology:assoc sxcoughno coughchest painno chest painfeversno fevertob useno tob useDDx includes but not limited to respiratory pathologyRespiratory exam (limited by triage setting):NADModerate distressCBTAralesrhonchicoarse breath sounds Plan:upregCXREKGduonebssteroidssyncopep/w syncopep/w pre-syncopePlanDiagnostically:POC glucEKG, trop, cbc, bmp, CXRbnplower extremity swelling – bilaterallyp/w bilateral LE edemaHPI (Limited by triage setting)OnsetAssoc featuresDDx includes but not limited to: CHF, nephrotic syndrome, hypo-albuminemia, chronic venous stasis, bilateral LE infection/cellulitis, less likely bilateral LE DVTs.Clinically not c/w nec fasc or NSTI at this time.Exam:NADC/w cellulitis in LEsNot c/w cellulitis in LEsLesions c/f infection PlanDiagnostically:upregEKGcbc, bmp, LFTs, UAESRTherapeutically:lower extremity swelling – unilateralp/w unilateral LE swellinglacerationp/w lacerationLocation:Examnuero-vasc-motor intact, hemostaticPlanupregimaging for FBtetanus deferred (already UTD)tetanus updated (unknown last, but suspected fully immunized)Laceration exploration/exam/repair per accepting MDtraumap/w traumaNAD, Normal cognitive statusImaging:CT headCTTetanusLabs:upregCBC, BMPLFTs, UAhead strikeback painheadachep/w headacheHPIhx of priorno red flag symptomsExam:Nuero grossly intact, no signs of traumaPlanupregCT deferred at this timecompazineIVFzofrantoradol (exceeding low suspicion for hemorrhage)tylenoljoint painp/w joint painHPIlocationExam:nuero-vasc-motor intactno pain on passive ROMPlanXRslabsAnalgesiavision problemp/w vision problemHPIbilateralunilateralleftrightNo hx of caustic irritantsCaustic irritants, threfore immediately moved to room for irrigation.Exam (perintent to complaint):nuero intact grosslyexternal ocular examPlanvisual acuityfull ocular exam/eval by accepting MDrequest for refill on medicationsp/w request for refill on controlled substances.p/w request for refill on non-controlled substances.Has PMDDoes not have PMDrequest to establish care p/w request to establish PMD for intake/eval of chronic conditionsadvised to follow up here for establishment of follow up careintoxicationp/w intoxication.Suspected substanceetohamphetaminescocainemarijunaopiodsExam (pertinent to complaint)somulentprotecting airway, satting wellagitated, redirectableagitated, refractory to verbal de-escalation attempts, requiring sedation, restraints for pt and staff safetyevidence of etoh withdrawalno evidence of etoh withdrawalsuicidal ideationhx of priorno hx of priorhas active plan,does not have active planhx of pysch d/ono hx of psych d/oPOC gluc wnl Plan“Medically cleared.” The patient does not have any acute medical emergency requiring medical intervention prior to psychiatric evaluation.medically cleared for psychiatric evaluation.The medical screening evaluation did not reveal any clear medical conditions which are thought to be more likely as causative to the patient’s psychiatric complaints than primarily psychiatric pathology.Given the most likely etiology for the patient’s symptoms at this time would require an emergent psych evaluation and the risks of delayed psychiatric evaluation outweigh the benefit of additional medical evaluation, the patient is to be evaluated by psychiatry.This emergency medical screening examination does exclude all underlying medical conditions which may be contributory or exacerbating the patient’s psychiatric complaints (as this is not feasible to be done in an medical screening exam). Additionally, the patient may have additional comorbidities/medical need which will need to be addressed on an non-emergent basis.Patient transferred to care of psychiatrist with safety-sitter for evaluation of patient’s psychiatrist complaints.To assist accepting team (and to be followed up by accping team):UtoxUpregCannot medically clear until more thorough medical evaluation givenSuspicion forPlan to faciliate ellucidation of medical etiology or clearance for psych:POC glucupregEKG labs: cbc, bmp,trop, CKingestion labs (ASA, tylenol level)CT headCXRUAutox (to be followed up by psych team)vaginal bleeding (pt doubts pregnancy)No anemic sx (no CP/SOB/sycnope/fatigue) Dx:upregPOC Hgcbc, bmp, type/screenUAPelvic US deferred given hx/exam not c/w torsion, necotric fibroid, TOA, ovarian cystvaginal bleeding in pregnancyEGAby LMPby US which shows IUPhas not had US confirmed IUPserum hcgcbc, bmp, type/screenpelvic USUA, UCxdysuriaupregUAUCx given age and/or morbidity and/or microbiological historyLabs: cbc, bmplab deferred given no systemic sx of infection, no flank pain. Contingent upon exam of accepting MD showing solely UTI, labs may be deferred.infectious systemsMeets SIRS criteriaBPnormotensivehypotensiveHx of immunocompromise:Suspected sourcePlanSeptic work-up: cbc, bmp, LFTs, lipase, BCx x2, lactate, UA, UCx, tropIVFAbx deferred for accepting team to iniate based upon suspected source.coughExam:abnormal breath soundswheezingralesrhonchiCXRduonebssteroidsmagnesiummagnesium deferred given well appearinglabs: cbc, bmpEKG/trop/ASAURI systemsNo hx of immunocompromise.Well appearing.Vitals not severe deranged suggestive of more malignant process.Plan for symptomatic relief, full eval by accepting practitioner.feverGiven well appearing and no e/o bacterial infection on triage exam, will defer further diagnostic to accepting practioner.upregSymptomatic reliefGiven ill appearing and/or comorbid, will pursue full septic work up:upregcbc, bmp, LFTs, lipase, UA, BCx x2, lactate, trop, CXRIVFAbx per accepting team based upon suspected source.Additional imaging given suspected source:Suspected sourceDispoAwaiting bedNext backBring back nowOf note, this is a limited medical screening exam. The history/exam is insufficient for compelte eval in the ED given the limitations of time and the intention of this exam is to determine initial diagnostics to expedite care by AED/RME team assuming care of patient. Further history and exam to be obtained per protocol by AED/RME team that subsequent to this examination assumes care of patient. As such, there is recognition that aspects of the history or exam may be incomplete given time limitations and inability to derobe nor keep patient on monitor for full evaluation. Patient educated that this is not a complete evaluation and the necessity of staying for full evaluation by AED/RME team.