Sometimes, I'm a dodo and it's good that I'm supervised.
Sixty-ish African-American lady who came in seeing mean white bugs on the walls, and colored squares on her body that came and went, as well as a new tremor, shortness of breath, and minimal chest pain, BP 210/120, HR 130, SOB. She was diaphoretic, tremulous, anxious. She had been seen at another ED and diagnosed with anxiety.
I did a careful history and physical. She was seeing squares at the time. 'Are they friendly?' I asked. I can't help but mess with psychotic people. 'I'm not sure', she said. My differential included thyroid storm, encephalopathy 2/2 the hypertension. The attending asked, 'does she drink?'
Well, @&*%$#!, I didn't ask. Back to the room.
Ma'am, do you drink alcohol?
How much, would you say, on average?
Oh, four or five drinks a day.
When did you drink last?
Well, New Year's Eve; that was five days ago.
Peak for DTs. I'm an idiot. 2 mg ativan IV and dispo done. Sheesh. Thyroid storm.