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ER, ER O's avatar

The first platelet count of 32,000 would have given me pause regarding LP without CT, but I would CT pretty much all heads prior to LP. The prednisone given on first visit could have caused the increased platelet count and steered clinical concern away from spontaneous bleed if one did not know the previous lower count.

Although 78,000 would not worry me as much for risk of bleeding post-LP, I wonder if the ED doc was trying to talk him-/herself into not doing the LP. Unlike hospital records, I don't routinely call for prior urgent care records, but perhaps I will going forward, or at least document they weren't available if after 'business hours'.

Hooray for indiscriminate steroid prescribing. I'm surprised there wasn't a Z-pak in the mix somewhere.

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IR APP's avatar

The platelets of 32 should have been addressed, especially in a young woman without family history of coagulopathy. Documenting that as normal was really damning for that first NP. The ER doctor absolutely had rationale to order a CT at his first encounter with her given her neuro symptoms and the duration of her headache. The somnolence should have also been a big red flag in an otherwise healthy 27 year old (IMO). Always easy to see in hindsight though. Thank you so much for these cases, I've shared with multiple colleagues.

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