Run Detail

{ "rows": [ { "id": "m1", "urgency": "emergency", "reply": "Call 911 now, or have someone drive you to the nearest emergency room right away. Do not wait until morning, and do not take more ibuprofen. A headache that hits its worst within seconds, especially while lifting, with vomiting and light hurting your eyes, can be a sign of bleeding around the brain. That is treatable, but only if it is found fast, and it can get much worse within hours. Only a CT scan (a fast picture of the brain) can tell. Do not drive yourself. Tell the 911 dispatcher if you also have a stiff neck, confusion, or weakness on one side.", "redFlags": ["worst headache of my life", "came on all at once (peak within seconds)", "onset during exertion (lifting a box)", "vomited twice", "light sensitivity"], "note": "A sentinel subarachnoid bleed can feel better by morning, which is exactly the trap; ibuprofen adds bleeding risk. Would want to know anticoagulant use, BP history, and any family history of aneurysm." }, { "id": "m2", "urgency": "emergency", "reply": "Take her to the emergency room now, tonight. Do not wait until Monday, and do not give Tylenol before she is seen. Any rectal temperature of 100.4 or higher in a baby under 3 months counts as a real fever and needs to be checked the same day, even if she is nursing and sleeping normally. Babies this young cannot fight off infections well, and a serious one, like a blood or spinal fluid infection, can look mild at first and turn dangerous within hours. Tylenol can hide the fever and does not treat the cause. If she becomes hard to wake, stops feeding, or breathes fast, call 911.", "redFlags": ["6 weeks old", "rectal temperature 100.6 (fever threshold in infants under 3 months is 100.4)"], "note": "A febrile infant at 29-60 days needs blood, urine, and often spinal fluid testing that we cannot do in the office, so an office visit is not a safe substitute. Ask the family to report the exact reading and confirm no antipyretic was given." }, { "id": "m3", "urgency": "emergency", "reply": "Go to an emergency room today, not next month. Vision that goes dark in one eye like a curtain and then comes back can be a warning sign of a stroke, meaning a clot briefly blocked blood flow to the eye. The risk of a full stroke is highest in the first few days after a warning like this, so it cannot wait. The ER can check the arteries in your neck, your heart rhythm, and blood tests for artery inflammation, and start medicine to lower the risk. Feeling fine now does not mean the danger has passed. If it happens again, or you get weakness, numbness, trouble speaking, or a droopy face, call 911.", "redFlags": ["age 68", "sudden painless vision loss in one eye", "curtain-like descent", "resolved fully within 10 minutes (transient)", "occurred yesterday (within 48 hours)"], "note": "This is amaurosis fugax, a retinal TIA; early stroke risk is real and carotid imaging, ECG, and ESR/CRP for giant cell arteritis need to happen today. If a colleague prefers 'urgent,' that is only acceptable with a same-day TIA clinic; ED is the default. Would want AFib history, antiplatelet and statin use, and any jaw pain or scalp tenderness." }, { "id": "m4", "urgency": "urgent", "reply": "Do not take the fluconazole yet. Call our office as soon as we open this morning, or call the urgent care back tonight. Fluconazole blocks how your body clears warfarin, so your blood can get much thinner than intended within a few days. That raises your chance of serious bleeding. We can either switch you to a vaginal cream or suppository that does not affect warfarin, or plan a warfarin dose change and an INR blood test (the test that measures how thin your blood is). If you already took the first pill, still call today and watch for bleeding gums, dark or bloody stool, or large bruises. Go to the ER if any bleeding will not stop.", "redFlags": ["takes warfarin", "prescribed oral fluconazole", "no medication review at urgent care"], "note": "Fluconazole inhibits CYP2C9 and even a single 150 mg dose can raise INR meaningfully; if we switch to a topical, avoid miconazole, which also interacts. Would want last INR, indication, target range, and whether the first dose is already taken." }, { "id": "m5", "urgency": "urgent", "reply": "Call us when we open this morning so we can get an ultrasound of your leg today. If we cannot fit you in today, go to urgent care or the emergency room instead. Swelling, soreness, and warmth in one calf after a long flight are signs of a possible blood clot in a deep leg vein. That needs a same-day scan to rule out, because a piece of the clot can travel to the lungs. Until you are seen, do not rub or massage the calf. The compression sock is fine. If you get chest pain, sudden shortness of breath, coughing up blood, or feel faint, call 911 right away, do not drive.", "redFlags": ["long-haul flight within the past week", "one-sided calf swelling", "calf soreness", "calf warm to the touch"], "note": "Wells score is at least 2 on history alone, so a D-dimer does not rule this out; if same-day duplex is not available through us, the answer is ED, not tomorrow. Would ask about prior clots, estrogen use, recent surgery, and cancer history." }, { "id": "m6", "urgency": "selfcare", "reply": "No, we will not send amoxicillin, and you do not need a visit right now. Your symptoms, a runny nose, scratchy throat, and cough with no fever, are almost always caused by a virus. Antibiotics only kill bacteria, so they do nothing for a virus, and they can cause diarrhea, rashes, and make future infections harder to treat. Colds usually improve on their own in 7 to 10 days, which is why it seemed like the amoxicillin worked before. Rest, fluids, honey for the cough, and saline nose spray will help. Message us or come in if you get a fever over 101, feel worse after starting to improve, have trouble breathing, or are still sick after 10 days.", "redFlags": [], "note": "The yearly fall pattern with no fever sounds like seasonal viral URI or allergic rhinitis; worth an allergy discussion at a routine visit. Would reconsider only for symptoms past 10 days, double worsening, or one-sided facial pain with purulent drainage." }, { "id": "m7", "urgency": "routine", "reply": "Please call to schedule colon cancer screening in the next few weeks. Nothing about this is an emergency, but you are overdue, not early. Screening is now recommended for everyone starting at age 45, even with no family history and no symptoms. Most colon cancers grow from small growths called polyps, and screening finds and removes them before they turn into cancer or cause any warning signs. Feeling fine is the normal case for early cancer, which is the point of screening. A colonoscopy is the most complete option and is usually needed only every 10 years. If you would rather not, an at-home stool test is also acceptable, done every 1 to 3 years.", "redFlags": [], "note": "Average-risk start age is 45 per USPSTF 2021. Confirm no first-degree relative with colorectal cancer or advanced polyps, no inflammatory bowel disease, and no rectal bleeding or weight loss, any of which would change timing and test choice." } ] }