drift-crazy-rushian
Eehhhh I’m always on the fence. I mean an MRI? If she’s otherwise cooperative and not fighting it? Sure. Is her urine clean? What is her baseline functionality/quality of life? I’d be more apt to work it up a little more aggressively if she was fully functioning with minimal deficit at baseline. But also more importantly, what does she want? Advanced directives? Family know what she would want?
pleasedotheneedful
If pt will cooperate and everyone is on board I would be ok with MRI. this gave me a flashback to a patient who was admitted on a saturday with stroke symptoms but no CT findings so they just hung out in the ICU for seizures with a low-priority neuro consult placed. neuro saw her on monday, repeat CT showed a big ischemic stroke. EM resident got their shit pushed in.
cranquis
like other comment said, first and foremost, what advance directives exist? what can family convey about her goals for quality of life?
I live in the city where no radiologist would give me MRI stat for 90something year old lady. I had to promise a free lunch whn I wanted an early MRI in a young female when I suspected RES.
And no advance directives from the patients. However the fam doesnt want to do any excessive procedures. The quality of life before was that she was able to move from the bed with the help of others, was able to walk for a short time. Now she is lying and not communicating. she isnt in any pain. Atleast doesnt seems like it.
My working diagnosis is brain infarct. we shall see how she will do tomorrow.
