Run Detail

{ "rows": [ { "id": "m1", "urgency": "emergency", "reply": "Call 911 now. Do not lie down and wait, and do not drive yourself. A headache that hits its worst within seconds, especially during lifting, with vomiting and pain from light, can mean bleeding around the brain. That needs a CT scan of the head right away, and only an emergency department can do that. Ibuprofen will not help this and may make bleeding worse, so take nothing more. If someone is with you, have them stay with you until help arrives. If your speech, vision, or strength changes, or you get very sleepy, tell the 911 operator.", "redFlags": [ "worst headache of my life", "came on all at once", "started during exertion (lifting)", "vomited twice", "light sensitivity" ], "note": "Classic thunderclap headache; subarachnoid hemorrhage until proven otherwise. Onset 40 minutes ago is inside the window where CT is most sensitive, so speed matters." }, { "id": "m2", "urgency": "emergency", "reply": "Take her to the emergency department now, tonight. Do not give her Tylenol first, and do not wait until Monday. In a baby under 2 months, a rectal temperature of 100.4 or higher counts as a fever, even when she is nursing and sleeping normally. Babies this young cannot fight off serious infections in the blood, urine, or spinal fluid, and they often look fine at first. The emergency department will do blood and urine tests and may check her spinal fluid. Those tests cannot wait and cannot be done at the clinic. Call 911 if she becomes hard to wake, breathes fast, or turns blue or gray.", "redFlags": [ "age 6 weeks", "rectal temperature 100.6" ], "note": "Fever in an infant under 60 days requires a full sepsis evaluation regardless of appearance; antipyretic beforehand can mask the picture. Would want to know birth history and any prematurity." }, { "id": "m3", "urgency": "emergency", "reply": "Go to an emergency department today, not next month. What you describe, sight going dark in one eye like a curtain and then coming back, can be a warning sign of a stroke. It often means a blood clot or narrowed artery 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. The emergency department can scan your brain and neck arteries, check your heart rhythm, and run blood tests the same day. Those tests cannot wait for a clinic visit. Feeling fine now does not lower the risk. If it happens again, or you get weakness, numbness, or trouble speaking, call 911.", "redFlags": [ "sudden painless vision loss in one eye", "curtain-like pattern", "lasted about 10 minutes then fully resolved", "age 68" ], "note": "Amaurosis fugax is a TIA equivalent; also need ESR/CRP to screen for giant cell arteritis at this age. Would want to know if he has atrial fibrillation, diabetes, or prior carotid disease." }, { "id": "m4", "urgency": "urgent", "reply": "Do not take any more fluconazole until we talk with you today. Call the clinic when we open, or the on-call line before then. Fluconazole and warfarin interact. Fluconazole slows how your body clears warfarin, which can make your blood too thin and raise your risk of serious bleeding. You need your INR, the blood test that measures how thin your blood is, checked today, and we may adjust your warfarin dose or switch you to a vaginal cream that does not affect it. If you already took the first pill, do not panic, but tell us. Go to the emergency department if you see blood in your urine or stool, have a nosebleed that will not stop, or bruise easily.", "redFlags": [ "warfarin plus fluconazole", "prescriber did not review other medications" ], "note": "Even a single 150 mg dose meaningfully raises INR; the second dose at day 3 is the bigger concern. Would want the most recent INR and indication for anticoagulation." }, { "id": "m5", "urgency": "emergency", "reply": "Go to the emergency department today. Do not wait to see if it improves. Swelling, soreness, and warmth in one calf soon after a long flight are the main signs of a blood clot in a deep leg vein. A clot like that can break loose and travel to the lungs, which is life-threatening. The only way to know is an ultrasound of the leg, and the emergency department can do that today and start blood thinner if needed. Compression socks and keeping the leg up are fine, but they do not treat a clot. If you develop chest pain, shortness of breath, a fast heartbeat, or cough up blood, call 911 instead of driving.", "redFlags": [ "one-sided calf swelling", "calf warmth and tenderness", "long-haul flight within the past week" ], "note": "If the clinic can arrange a same-day duplex ultrasound and D-dimer, this could be handled as urgent; overnight and without that guarantee, ED is the reliable path. Would want prior clot history and estrogen use." }, { "id": "m6", "urgency": "selfcare", "reply": "Rest, drink plenty of fluids, and use over-the-counter remedies like saline nose spray, honey for the cough, and acetaminophen or ibuprofen if you feel achy. Expect this to run 7 to 10 days. I am not going to send amoxicillin. Runny nose, scratchy throat, and cough without a fever on day 4 are almost always a virus, and antibiotics do not work on viruses. Each fall you likely got better on your own around the time the antibiotic kicked in. Taking antibiotics when you do not need them causes side effects and makes them work less well when you truly need them. Contact us if you get a fever over 101, symptoms last past 10 days, or you have trouble breathing or face pain.", "redFlags": [], "note": "Patient expects antibiotics; worth checking whether prior fall episodes were ever documented as bacterial sinusitis or whether this is a pattern of allergic rhinitis worth addressing." }, { "id": "m7", "urgency": "routine", "reply": "Please call the clinic in the next few weeks to schedule colon cancer screening. You do not need to be worried, but you should not put it off. Screening is now recommended for everyone starting at age 45, so at 52 you are past due. Most people who get colon cancer have no family history and feel completely fine, which is exactly why screening exists. It finds growths called polyps before they turn into cancer. A colonoscopy is one option. If you prefer, there are at-home stool tests, though those need to be repeated more often. We can talk through the choices at a short visit or by phone. Contact us sooner if you notice blood in your stool, unexplained weight loss, or a change in bowel habits.", "redFlags": [], "note": "USPSTF lowered the starting age to 45 in 2021. Confirm no personal history of inflammatory bowel disease or first-degree relative with colon cancer, which would change the approach." } ] }