Run Detail

{ "rows": [ { "id": "m1", "urgency": "emergency", "reply": "Do not wait until morning. Go to the nearest emergency room now, or call 911 if you feel too unwell to drive. A headache that hits all at once and is the worst you have ever had can mean bleeding around the brain, and the only way to rule that out is a CT scan, which is done at the hospital. The ibuprofen will not fix this if it is a bleed. Do not take any more ibuprofen or aspirin on the way in, because if there is bleeding, those thin your blood. Bring a list of your medicines. Tell the triage nurse exactly what you told us: sudden onset, lifting, vomiting, light sensitivity.", "redFlags": [ "worst headache of my life", "came on all at once", "while lifting a box", "threw up twice", "light is killing me" ], "note": "Would want to confirm no anticoagulant use and exact last-known-well time from chart. If the patient is on any blood thinner, the ER needs to know immediately before imaging." }, { "id": "m2", "urgency": "emergency", "reply": "No, do not give her Tylenol, and do not wait until Monday. A fever of 100.4 or higher in a baby under 3 months old needs to be checked in person today, at an emergency room. At 6 weeks her immune system is still very young, and a fever can be the only sign of a serious infection like a urine or blood infection. The ER will do a blood test and a urine test to make sure nothing is going on. She nursed and is sleeping, which is reassuring, but it does not change the need for the tests. Bring her in now. If she becomes hard to wake, turns blue, or has a seizure, call 911.", "redFlags": [ "6 weeks old", "rectal temp 100.6" ], "note": "AAP recommends full septic workup (blood cx, urine cx, possible LP) in a hospital setting for febrile infants <82 days. Would want to confirm immunization status and any prior febrile episodes from chart." }, { "id": "m3", "urgency": "emergency", "reply": "Do not wait for your physical next month. Go to the emergency room today. A curtain of darkness dropping over one eye, even if it goes away, can mean a small blood vessel in the eye or the brain was briefly blocked. At 68, that is a warning sign that a larger vessel could close, which would cause a stroke. The ER can do a CT scan and blood-vessel imaging to check for that. It can also flag the need for a same-day dilated eye exam to look for a tear in the retina. Tell them exactly what you told us: right eye, curtain from the top, about 10 minutes, fully resolved.", "redFlags": [ "68 years old", "right eye went dark like a curtain coming down from the top", "lasted about 10 minutes" ], "note": "Complete resolution argues against a full retinal detachment but does not exclude a small retinal tear or transient ophthalmic/retinal artery occlusion. Would want to confirm vascular risk factors (HTN, diabetes, smoking, AFib) from chart." }, { "id": "m4", "urgency": "urgent", "reply": "Stop before you take the next pill, and call your warfarin prescriber or pharmacist today. Fluconazole blocks the liver enzyme that breaks down warfarin, so your blood-thinning level (INR) can climb higher than safe and raise your bleeding risk. The urgent-care doctor did not have your full medicine list, which is why nobody flagged it. Your prescriber will tell you whether to skip the fluconazole, switch to a different antifungal, or take it and get a blood test in three to four days. Do not just take it and hope for the best.", "redFlags": [ "warfarin", "fluconazole" ], "note": "Fluconazole 150 mg x 2 is a moderate CYP2C9 interaction with warfarin. Would want to confirm current INR and warfarin dose from chart. If the first dose is already taken, an INR check in 3-5 days is prudent." }, { "id": "m5", "urgency": "emergency", "reply": "Go to the emergency room today. A one-sided swollen, sore, warm calf after a long flight is a classic sign of a blood clot in the leg (deep vein thrombosis, or DVT). You need a Doppler ultrasound, which is a sound-wave scan of the veins, to confirm or rule it out. The compression sock and elevation are fine to keep doing, but they do not replace the test. If the clot is there, you will need blood-thinner medicine to stop it from breaking off and traveling to your lungs. If you develop chest pain, sudden shortness of breath, or cough up blood before you get there, call 911.", "redFlags": [ "flew back from Tokyo", "left calf swollen and sore", "warm to the touch", "right one is fine" ], "note": "Wells score likely moderate-high given recent long-haul flight plus unilateral symptoms. Would want to confirm no prior DVT/PE history and no current anticoagulation from chart. D-dimer has low specificity post-flight and may not be helpful." }, { "id": "m6", "urgency": "selfcare", "reply": "No, I am not sending an antibiotic. What you describe—four days of runny nose, scratchy throat, cough, no fever—fits a common cold, which is a virus. Amoxicillin kills bacteria, not viruses, so it will not shorten this. The reason it seems to 'clear it up' is that colds resolve on their own in seven to ten days, and the antibiotic just happens to be in the picture. For now: rest, fluids, honey in warm water for the cough, saline nasal spray. Call us back if you develop a fever over 101, symptoms that improve then suddenly worsen, or facial or ear pain getting worse, because that could mean a secondary bacterial infection that would need a visit.", "redFlags": [], "note": "Patient's belief that amoxicillin 'clears it up' is likely the natural 7-10 day course of a viral URI. Would want to check chart for prior antibiotic prescriptions to assess a pattern of overuse." }, { "id": "m7", "urgency": "routine", "reply": "You do not need to worry, but you are due. Current guidelines say to start colon cancer screening at age 45, and at 52 you are past that mark. A colonoscopy is a camera on a thin tube that looks at the inside of your large intestine. It catches small growths called polyps, which can be removed right then and there before they ever become cancer. Having no family history and feeling fine is great, but the test is still recommended because most polyps cause zero symptoms. Call our office this week to schedule it. We will send you prep instructions a few days before.", "redFlags": [], "note": "ACS updated screening start to 45 in 2021; USPSTF still says 50. Either way, at 52 this patient is due. No family history means average-risk 10-year interval applies. Would want to confirm no prior GI workup or FOBT history." } ] }