Saturday, September 10, 2005

double down

Part of what you learn in school is luck. Did you see a patient with an aortic aneurysm? If so, you're unlikely to forget how it presents. If you read about it and learned about its clinical presentation, well, that's just not as good. At least for new FNP. So today I saw what I am almost certain was herpes.

Grouped vesicles on an erythematous base? Check.

History of similar outbreaks that resolve without treatment? Check.

Discomfort? Check.

Genitals? Check.

Thankfully, we have the requisite derm picture book in the office and I was able to compare my mental picture of the lesion with the book. It matched. The instant I saw it on the patient, I thought "herpes," but I just didn't trust my gut. I'll be interested (in an utterly academic manner) to see what the viral culture shows. Let's just say that the counseling was difficult today and, of course, it was in Spanish.

Did you all see periorbital cellulitis in your clinical rotations? Well I didn't, but I sure read about it and understood its severity. That was why I was freaked as shit to see a big ole swollen eye today. I have seen some conjunctivitis in my day, but I've never seen something that looked like the trailer from that movie "Hitch" or whatever it's called with Will Smith. Well, this kid's eye was sw-ol-len! As I did with most patients today (it was one of those days), I consulted. I guess sometimes eyes just swell from allergic/viral/bacterial conditions. Thus, the "-itis." BTW, of course new FNP examined this kid's EOMs and pupillary response, lest anyone think new FNP is a total schmuck. All normal.

And finally, the rash. New FNP is very sensitive to the allergic reaction as she has had several in her day. The freaky thing is when all of your Magnum P.I. skills fail to elicit the etiology of the rash. Thankfully, there was no respiratory involvement so a little diphenhydramine should do the trick. Until next time, which is the part I don't like.

Let's see - on my list of shit to learn today is:

ferrous sulfate therapy - infants
uterine prolapse (asymptomatic)
how to keep my shit together

This list is not all-inclusive, but new FNP is tired and has had a glass - OK, two glasses - of wine tonight. Ah, sweet, inviting, new Spring Air mattress... it has been 24 hours and I need you!

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