Hyperaldosteronism and Renal Artery Stenosis in a Post-Abdominal Aortic Aneurysm Patient: A Case Report.

INTRODUCTION: Patients with history of abdominal aortic aneurysm (AAA) undergoing surgical repair can have a myriad of surgical complications including compromise to large arteries branching from the aorta. Secondary hyperaldosteronism, characterized by high levels of aldosterone and renin, can be due to a multitude of causes, including renal artery stenosis, and presents with nonspecific symptoms of fatigue, increased thirst, and muscle spasms. While it can initially be difficult to diagnose given its multitude of metabolic abnormalities, secondary hyperaldosteronism is important to consider in patients presenting with uncontrolled hypertension, hypokalemia, and metabolic alkalosis. CASE REPORT: This report explores the case of a 65-year-old male with a complicated medical history presenting to the emergency department with hypokalemia and hypertension six months after undergoing endovascular repair for an AAA and was found to have metabolic abnormalities including hypokalemia and metabolic alkalosis consistent with secondary hyperaldosteronism, likely secondary to renal artery stent stenosis. He was admitted to the hospital for four days and made a full recovery. CONCLUSION: This case highlights the need to understand, identify, and accurately diagnose hyperaldosteronism and recognize post-AAA repair complications of renal artery stenosis as a cause of this metabolic derangement.

Assessing medical student documentation using simulated charts in emergency medicine.

BACKGROUND: The 1995 Health Care Financing Administration (HCFA) guidelines stated that providers may only use the review of systems and past medical, family, social history in student documentation for billing purposes; therefore, many providers viewed the student documentation as an extraneous step and chose not to allow medical students to document patient visits. This workflow negatively affected medical student education in documentation skills. Although the negative impact on students' documentation skills is obvious, areas of deficits are unknown. Understanding the area of deficits will benefit future curriculums to prepare prospective resident physicians for proper documentation. We aimed to assess areas of deficits in documentation of fourth-year medical students according to HCFA billing guidelines. METHODS: We conducted a prospective study of fourth-year medical students' simulated chart documentations at a United States medical school from May 2014 to May 2015. We evaluated students' simulated charts from an online learning tool using simulated cases for completeness according to HCFA guidelines and analyzed data using descriptive statistics. RESULTS: We found that 98.9% (n = 90) of the charts were downcoded. Of these charts, 33.0% (n = 30) had incomplete history of present illness, 90.1% (n = 82) had incomplete review of systems, 73.6% (n = 67) had incomplete past medical, family, social history and 88.8% (n = 80) had incomplete physical exams. CONCLUSION: New curriculum should include billing guideline information and emphasize the completeness of charts according to acuity.

Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician.

Patients commonly present with an acute red eye to the emergency department (ED). It is important to distinguish between benign and sight-threatening diagnoses. Here we provide a comprehensive overview on the acute red eye in the ED.