I group terrible medical problems into those that explode and those that ramp up. For you math brains, explosions are step functions. Some aneurysms, strokes and pulmonary emboli fall into this category. Things that ramp up get worse exponentially. Infections like appendicitis, meningitis, cholecystitis and necrotizing fasciitis (flesh eating bacteria) fit here. Every bad infection starts off as a not so bad infection. So the question for patients is where/when on the curve is it time to seek help. And the question for doctors is when to go nuts with testing and treatments.
One hard part about emergency medicine is that we have limited access to those illness progression curves. We have a brief moment in time to make decisions. Of course, we can hang onto patients for hours to watch their illnesses progress, but that generally gums up the conveyor belt. So if there is any concern for serious infection, we go deep and fast. IV fluids, blood counts, blood cultures, wound cultures, lactic acid levels, X-rays, antibiotics ASAP…
The broader topic is called “sepsis,” and today our care for sepsis is being highly scrutinized. So if you arrive with an elevated heart rate and fever, you just might be launched down this path. Maybe we’re saving more lives with our rigorous protocols, but we’re certainly amplifying the bills.
In any case, one reason that I like Pre-R is because I have more time to assess “slopes.” That’s another way of saying that I like follow up over days, and being able to work with patients to see if their problems are getting better or worse, quickly or slowly.
And that blister… It healed just fine.