Yesterday I had a couple of interesting / uncommon consults:
Within gastroenterology, a food impaction that lodged in the distal esophagus (right before the entry point into the stomach). This typically requires either antispasmodics (to reduce muscle tension at the end of the esophagus so that the food can pass through) or an immediate endoscopy (scope going into the esophagus). Our gastroenterology team chose to do an endoscopy because this patient previously required an endoscopy for a similar issue a few months prior. He tends to eat very quickly and not chew his food well - so let this be a lesson to chew to your food well!
The other interesting consult from yesterday was neurologic in nature. A man with prior kidney cancer (kidney was removed, and he was free of cancer as of around March of this year) started being suddenly confused and speaking unclearly. First thing to rule out in the ED is a stroke, but when you know there's a history of cancer with new cognitive / neurological changes, the mind jumps to a possible spread of cancer to the brain. Unfortunately, this is exactly what it was. Imaging showed that there was a bleed surrounding a mass, with edema surrounding the bleed. Other masses within the brain were found as well. The patient went to the neurosurgical ICU for observation and will require some brain surgery, plus further treatments in the future. This was a very devastating but interesting find, especially since this patient exhibited something called Wernicke's aphasia (due to the location of the tumor, he was speaking fluently, but the content of his speech did not always make sense, plus he did not process some colors that he was being shown).
On the contrary tonight's consults were rather boring / common: a small and stable gastrointestinal bleed, and a stroke code called on a patient who had similar symptoms in October and was determined to be having adjustment disorder with anxiety component (in other words, psychiatric symptoms - not a real stroke). I wasn't thrilled to do the second one because I was literally about to fall asleep when this stroke code was called, only to discover that this was psychogenic - at 3:30 a.m.! Take your anti-anxiety pills and other medications correctly, and you won't have weird symptoms and end up hospitalized in the middle of the night, silly lady.
OK, time to get going. I'd rather be getting my sleep at home so that I don't get annoyed by having it interrupted at work lol!
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