Site Evaluation Presentation Summary

For my final site evaluation, I presented on a case of a 94 year old female who came into the ED c/o mild, crampy abdominal pain associated with episodes of coffee-ground emesis and black, tarry stools that was admitted to the medicine floor of Mount Sinai before being transferred for rehab at Gouverneurs. All of her symptoms were acute and occurred over the span of several days. In the ED, an esophagogastroduodenoscopy revealed 3 non-bleeding duodenal ulcers. The patient’s Hb/Hct also dropped to a point where she needed 7 units of PRBC so the risk of recurrent GI bleed was high and concerning.

As for the ROS and PE examinations, the patient admitted to fatigue and generalized, mild, crampy pain/discomfort but reports that the episodes of vomiting and tarry stool have stopped. On examination, I was able to find indications that the patient was anemic with pale conjunctiva and discovered a pressure ulcer near the sacrococcygeal area, which was important in initiating preventing infection protocol and moving the patient often to prevent subsequent pressure ulcer formations.

During the mid-site evaluation, Dr. Davidson emphasized the importance of performing a good physical exam since the patient that I presented for the mid-site evaluation was s/p stroke. For stroke patients, it is important to do tests that test motor function, sensory function, and proprioception to see if we could isolate any deficits that occurred as a result of the stroke. Additionally, she mentioned that I should do the MMSE on all patients, even if the patients do not have a history of dementia. For a skilled nursing facility, social history is especially important since it is part of how the patients are discharged. For the final site evaluation, I made sure to conduct a more thorough physical exam and ask about living circumstances to help manage the patient for discharge.

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