Presentation:
Meet Max. He is a pleasant 61-year-old male with a medical history of congestive heart failure. Max was hospitalized for 6 nights after presenting in the ED with atrial fibrillation with rapid ventricular response and lower extremity edema. Max was identified as being at high risk for readmission after discharge. His hospital case manager requested Bridge Care to follow up with Max within 48-72 hours.
DispatchHealth Visit
-Upon arrival at Max’s home, he was happy to report that we has continued to feel better since being released from the hospital. Max reported having occasional shortness of breath and lower extremity edema but denied any chest pain or shortness of breath at time of visit. During the visit the DispatchHealth APP assessed his vitals, reviewed discharge paperwork, and completed their clinical exam. It was discovered that Max’s O2 was 88%. A breathing treatment was administered improving the O2 saturation and a script for ongoing Ipratropium/Nebulizer was called in. APP checked labs on-site discovering Max was hypokalemic, a dose of potassium chloride was administered on-site and a prescription for oral potassium was ordered for follow up treatment.
-During the musculoskeletal exam it was discovered Max has post-inflammatory hyperpigmentation venous statis discoloration with erythema bilateral lower extremity to the level of the mid tibia and tender to palpation, 3+ pitting edema from feet to upper calves bilaterally, parts of the dorsal aspect of each foot is macerated due to excess moisture, and peripheral pulses 2+ bilaterally. IV Furosemide 20mg was administered to add in the reduction of the extremity edema. A follow-up visit was scheduled in two days with Bridge Care team. They are happy to report Max was improving and reports he is feeling better every day.
Outcome:
Thanks to the DispatchHealth Bridge Care team Max was able to avoid a trip back to ED, his PCP was updated on the new medical findings and care provided, and Max was able to recover comfortably at home.
