The Curious Case of the Dizzy Female

HPI

A curbside consultation was requested by a physician for a patient who was being discharged home.  The hospitalist physician verbally related the following synopsis on the patient:

This was a 59 year old African-American female who was admitted to the hospital with chief complaint of chest pain. She was admitted to the Cardiology unit, and underwent medical workup. She was negative for any ischemic, or, rhythm abnormalities and there was no failure of the heart pump. At time of discharge she complained to the physician of being unable to ambulate. The physician wants an opinion in clearance for discharge.

Physical Examination

Observation: Middle-aged, African American female, appearing stated age, well nourished, sitting up in bed, in no obvious distress.

Vitals: BP: 114/74 supine; HR – 79; RR – 14; SaO2 – 98% on RA.

Systems Review:

Cardiac: Heart Sounds S1, S2. No murmurs, no bruits.

Lungs: CTAB

Motor: UEs – 5/5. LEs bilaterally 0-1/5.

Sensory: Intact to CT/JPS bilaterally

Reflexes: DTRs – 2+ in UEs’ & LEs

Coordination – FTN is normal; No tremors. HST – Unable on command.

Special Test: Dix-Hallpike – Equivocal bilaterally.

Function – Able to sit up – needs hands to assist legs to EOB. Able to scoot. Unable to stand or too afraid. States this is since last 2-3 hours after physician rounds.

Assessment

At this time, please list every possible reason you can think of of WHY do you find the patient in the current situation?

To do this, you will need to have a verifiable PROBLEM LIST.

So, What are the PROBLEMS? >>> WHY are the problems present (i.e. Causation).

You may or may not need to request specific confirmatory tests – but you have to be clear in your mind on what specific test you would want in this situation.

If you can arrive at plausible WHYs, you have solved the problem. The treatment of the underlying CAUSE (the so called “WHY”), is the resolution of the patient’s symptoms.

Everything else as a part of PT is supportive measures – Education, and Prophylactic.

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