A 27-year-old woman with no past medical history complains of dizziness, palpitations, nausea, and sweating intermittently over the past few months. She worked as a receptionist for the past two years for a real estate agency while she studied to be an agent. A few weeks ago, she began to work as a realtor and she relates that her symptoms are more frequent and intense; she now feels mentally “cloudy” and is exhausted at the end of her work day. The woman comes to the ED today because she is afraid that this is affecting her performance and that she will lose her job.
In the ED, she is comfortable if not slightly anxious. T 99.9 HR 89 BP 118/70 RR
12 SpO2 98% on ambient air. She is a thin woman with normal heart, lung, and neurologic examinations. After ordering an electrocardiogram and select auxiliary laboratories, you expect to reassess and discharge her, but when you return to the bedside you see her nervously pacing. You notice that bilateral legs are ruborous without evidence of edema. Her repeat vital signs are significant for BP 124/80 HR 124. She has an otherwise normal repeat examination. She feels “cloudy” again.
After IV fluids, a normal investigation, and an unremarkable brief observation period, your patient feels well and wants to go home.
What is your best advice for her until a diagnosis can be established?
A. Follow a low-sodium diet
B. Rest as much as possible until you see your primary care physician
C. Avoid hot environments
D. Wear loose-fitting clothes when at all possible
In the meantime, a quote –
The two fulcra of medicine are reason and observation. Observation is the clue to guide the physician in his thinking.
– Giorgio Baglivi (1669-1707), Professor of Anatomy at Sapienza, Papal University, Rome
Introduction to De Praxi Medica
In the ED, she is comfortable if not slightly anxious. T 99.9 HR 89 BP 118/70 RR
12 SpO2 98% on ambient air. She is a thin woman with normal heart, lung, and neurologic examinations. After ordering an electrocardiogram and select auxiliary laboratories, you expect to reassess and discharge her, but when you return to the bedside you see her nervously pacing. You notice that bilateral legs are ruborous without evidence of edema. Her repeat vital signs are significant for BP 124/80 HR 124. She has an otherwise normal repeat examination. She feels “cloudy” again.
After IV fluids, a normal investigation, and an unremarkable brief observation period, your patient feels well and wants to go home.
What is your best advice for her until a diagnosis can be established?
A. Follow a low-sodium diet
B. Rest as much as possible until you see your primary care physician
C. Avoid hot environments
D. Wear loose-fitting clothes when at all possible
In the meantime, a quote –
The two fulcra of medicine are reason and observation. Observation is the clue to guide the physician in his thinking.
– Giorgio Baglivi (1669-1707), Professor of Anatomy at Sapienza, Papal University, Rome
Introduction to De Praxi Medica
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