ok, so this was awesome. I walk into the ER yesterday and start discharging Pts like a fiend (filled up immediately after, and today was even worse chaos). There was one lady who was seen by the O/N doc, a semi-private who sometimes takes call to fill gaps (though one day didn't show up at all!) and dx'd w/ enteric fever/typhoid. I go in to see the lady, stacked Monte style three abreast in one little room. She looks ok for an elderly Liberian woman and says she feels ok to go (not as useful an indicator of being ready to go as you might think...). Anyway, I write up her d/c stuff for standard abdominal pain meds, including anti-helminthics. I realize I forgot to do her abdominal exam, (it wasn't documented from the prior doc either) so I go back in and have her lie down and start pushing on her belly. I'm starting to think "you know, she's a little distended..." when all of a sudden she complains of "water" in her chest, and looks like she's about to vomit. We sit her up and give her a pan just in time to catch this diagnosis:
Round worm (ascaris) is an intestinal helminth/parasite. Her burden of disease must've been pretty extensive-- they live in the intestine, so by the time they're coming out your mouth you have quite a collection going on. So yeah, totally awesome.
--aws
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