Monday, July 17, 2006

But it's 4:53 PM

Here is the patient who should be the 4:45 walk-in: tinea, 1 lesion. That's it. You have ringworm, welcome. Please come in and accept my anti-fungal treatment. And then leave so that newFNP can too leave in order to make it to her overcrowded, under-air-conditioned gym prior to all of the elliptical machines being hogged.

Here is the patient who should not be the walk-in at the aforementioned time: the never before seen in our clinic 63-year old lady with the visibly pulsating carotid. It wasn't small, nor was it subtle. It was reminiscent of the boils on the truck driver's neck in 'Harold & Kumar Go To White Castle,' a must-see movie as far as newFNP is concerned.

In considering this patient, newFNP has but two words: time bomb.

Carotid bruit? No. Hugely wide carotid with a loud - and newFNP does mean loud as all getout - pulse. Is it an aneurysm? Possibly. Whatever it is, it needs more in-depth evaluation than newFNP's little community health clinic can provide. And did I mention that her BP was 144/40? Well, it was. NewFNP likes to call that a "wide" pulse pressure.

So, to sum up: wide pulsating carotid + wide pulse pressure = good-bye pulsing neck lady. Enjoy the ED. NewFNP sincerely hopes that this trip will save her patient's life.


FNP to be said...

Glad you are back. I am a soon to be FNP (as soon as I take and pass ANCC exam) who has been following your blog for several months now. I appreciate your sense of humor and the way you have dealt with your first year. Thanks for showing us we can make it and actually make a difference in the lives of others.

Anonymous said...

so, what was her chief complaint?