Behavioral Health


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M23_F3.jpg"}},{"insert":"\n\n"},{"insert":"It\u0027s five minutes to the end of your shift and you\u0027re longing for home. An unopened bottle of red wine awaits; and you begin to think of the meal you\u0027d like to pair with it.\n\nA sudden knock at the door snaps you back to the present, quite unceremoniously.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M23_F4.jpg"}},{"insert":"\n\n"},{"insert":"A young lady walks in, introducing herself as Amber, a 22-year-old student at the local university. She is visibly distraught and does not meet your eye.\n\n\u0022I\u0027ve been having this odd pain in my legs for the last couple of days. It\u0027s hard to walk. Yesterday I suddenly couldn\u0027t breathe during class, like a weight was holding my chest down.\u0022\n\n\u0022Have you been having palpitations too?\u0022 you ask, and she nods in the affirmative.\n\n\u0022What about similar symptoms previously, hyperventilation, or a feeling of impending doom, like something terrible might happen, but you don\u0027t know exactly what?\u0022\n\n\u0022No, none of those, doctor,\u0022 she responds, still not meeting your eye.\n\nAmber also denies having a cough, wheezing, chest tightness, or easy fatiguability. You inquire about school to which she replies shortly, sounding somewhat subdued: \u0022It\u0027s fine.\u0022\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M23_F5.jpg"}},{"insert":"\n\n"},{"insert":"You request to examine her and she agrees.\n\nHer pulse rate is 76 bpm with a respiratory rate of 18\/min. Her blood pressure is 100\/70 mmHg. The general examination and examination of systems show no abnormalities.\n\nYou note that Amber is slightly withdrawn throughout the examination. As she alights from the couch, she adds, \u0022I\u0027ve also had this crawling sensation lately that begins in my legs and spreads through my body.\u0022\n"}]}


{"ops":[{"insert":"You attempt to connect the dots between Amber\u0027s symptoms and lack of demonstrable signs but seem to be getting nowhere.\n\nWhat do you do next?\n"}]}
1. Refer her for a psychiatric evaluation
2. Attempt to get a more detailed history
3. Order a full blood count, electrolyte assay, and an abdominal ultrasound