CONTACTS
SUBJECTS
Examination Kaiser Urgent Care Right Eye Left Eye Head Patient Still
1603 -
1603 - ..
1604 - Summary/Objective
1605 -
160501 - Follow up ref SDS 23 0000. ref SDS 21 0000.
160502 -
160503 -
160504 -
160505 -
160506 -
160508 - ..
1606 -
1607 -
1608 - Progress
1609 -
160901 - We went to the Minor Injury Clinic on the ground floor of Kaiser
160902 - hospital in Walnut Creek, per planning on Saturday, 080202.
160903 - ref SDS 23 546N
160905 - ..
160906 - Doctor Jeffrey John Malone examined Millie's right arm and eye, which
160907 - were injured by a fall at home on 080125. ref SDS 20 N65K
160908 -
160909 - [On 090731 1330 Millie treated again in Minor Injury Clinic
160910 - recover from injury falling on stairs. ref SDS 29 RB5J
160912 - ..
160913 - Vitals...
160914 -
160915 - Blood Pressure
160916 -
160917 - 155 90
160918 -
160919 - Pulse
160920 -
160921 - 65
160923 - ..
160924 - Temperature
160925 -
160926 - 97.2 F 36.2 C
160928 - ..
160929 - Pulse and blood pressure are high for Millie. Pulse normally
160930 - registers below 60. Elevated vitals reflect emotional stress reviewed
160931 - recently on 080201 with Mental Health. ref SDS 22 N65K
160933 - ..
160934 - Millie reported recommendations on 080131 by Catherine, her nurse at
160935 - UCSF for chemotherapy cancer treatments, that Millie's treatment for
160936 - pulmonary embolism with Coumadin creates high risk from injuries
160937 - Millie suffered on 080125. ref SDS 20 N65K Today, the right eye is
160938 - much better, and the left eye is mostly healed. Since the right arm
160939 - is not recovering as quickly, we discussed getting an examination at
160940 - Kaiser ER, which Catherine suggested should have been done.
160941 - ref SDS 21 UJ8N
160942 -
160943 - [On 080207 0900 severe bruising noted by Doctor Rugo during
160944 - examination for cancer treatment; doctor asks if Millie
160945 - wants to consult social worker report cause and prevent
160946 - further injuries. ref SDS 25 QY5I
160948 - ..
160949 - Millie further reported today blood tests at UCSF on 080131 were all
160950 - normal, and that NEUTS (ANC at Kaiser) had actually increased
160951 - significantly to the safe level for chemotherapy treatment.
160952 - ref SDS 21 VJ8L
160954 - ..
160955 - Millie reported mild pain in the right arm, about a 4 on the 1 - 10
160956 - pain scale.
160958 - ..
160959 - Doctor Malone found no evidence today of fracture or major trauma that
160960 - requires treatment. Her face, right arm and side still look very
160961 - badly bruised, with very dark skin over about 80% of the arm and right
160962 - side.
160964 - ..
160965 - The doctor squeezed Millie's upper right arm and Millie said this
160966 - causes increased pain. The doctor explained this is normal reaction
160967 - to a bad fall.
160969 - ..
160970 - The doctor decided not to take xrays to check for concusion damage to
160971 - the head, nor test for fracture to the right arm.
160972 -
160973 - [On 080207 0900 severe bruising noted by Doctor Rugo during
160974 - examination for cancer treatment; doctor asks if Millie wants
160975 - to consult social worker to report cause and prevention of
160976 - further injuries. ref SDS 25 QY5I
160978 - ..
160979 - [On 080305 Millie complained of pain in the right arm when
160980 - lifted laterally to the vertical position; xray ordered.
160981 - ref SDS 27 5M39
160983 - ..
160984 - [On 080307 xray of right arm and shoulder negative; no findings
160985 - of fracture or trauma. ref SDS 28 IT8N
160987 - ..
160988 - Millie said today the right upper arm is recovering, i.e., slightly
160989 - better than yesterday.
160991 - ..
160992 - The doctor explained Millie suffered...
160993 -
160994 - ...a mild head injury. Often, people cannot remember what
160995 - happened right before and right after a head injury. Some head
160996 - injuries can cause you to black out, or lose consciousness, for
160997 - a few seconds or minutes right after the injury.
160999 - ..
161000 - The doctor explained a number of issues about head injuries, and his
161001 - findings in the examination today.
161003 - ..
161004 - The doctor indicated that using a heating pad for 20 minutes 4 times a
161005 - day may speed recovery of the left arm injury. He clarified that
161006 - immediately after an injury to an arm, ankle, knee, head, etc., icing
161007 - the injury for several days can reduce swelling, which speeds
161008 - recovery. After icing for a day or 2, then a heating pad on this type
161009 - of injury further aids recovery.
161011 - ..
161012 - Doctor Malone advised that Millie can take an over-the-counter drug
161013 - like Motrin to control in the right arm, while the injury heals. He
161014 - said that if the pain continues for another 5 days or so, Millie
161015 - should return to the Minor Injury Clinic for an xray to evaluate for
161016 - fracture. He feels sure today there is no fracture, and so an xray
161017 - will not be necessary.
161019 - ..
161020 - [...below in the record today on 080204 the doctor's Special
161021 - Instructions list Advil and Motrin for controlling pain.
161022 - ref SDS 0 GV9H
161024 - ..
161025 - [On 080204 Gloria in Kaiser Coagulation Control Clinic
161026 - recommended patients taking Coumadin, use Tylenol to control
161027 - pain rather than Motrin, because Motrin can cause internal
161028 - bleeding, which Coumadin can make life threatening. ref SDS 24
161029 - S65I
161031 - ..
161032 - [On 080226 Millie's letter confirms telecon notifying
161033 - Kaiser Coagulation Control Department of bruising from
161034 - fall on 080125. ref SDS 26 S13Y
161036 - ..
161037 - Millie asked the doctor to enter this advice for the record in the
161038 - Medical Chart, like reporting submitted by the primary care physician,
161039 - for example on 080118. ref SDS 18 YT5N
161041 - ..
161042 - The doctor left the room. He returned in about 10 minutes with a
161043 - stack of paper stapled together. The doctor said he cannot submit the
161044 - record on work performed today to the patient, because the Minor
161045 - Injury Clinic is not on that system.
161047 - ..
161048 - Millie asked the doctor to notify the primary care physician about
161049 - results of examination today. The doctor said he would make that
161050 - notification.
161052 - ..
161053 - The doctor handed Millie the stapled documents, which he described as
161054 - "Special Instructions."
161056 - ..
161057 - Review after the meeting shows that Kaiser Special Instructions
161058 - contain standard explanations for head injuries, and nothing about
161059 - findings from examination today. The papers say in part...
161061 - ..
161062 - Special Instructions...
161063 -
161064 - The doctor or other health care professional carefully checked
161065 - you and did not find a serious head injury. But sometimes
161066 - problems can develop later. This is why you need to be with
161067 - someone who can watch you closely for the next 24 hours. Talk
161068 - with your doctor or other health care professional about
161069 - follow-up care.
161071 - ..
161072 - This narrative is generally interesting, but fails to report the date
161073 - of the injury on 080125, which conflicts with instructions today on
161074 - 080204 to monitor the patient for 24 hours.
161076 - ..
161077 - Guidance in the last sentence to get instructions for follow up care
161078 - was implemented by asking the doctor for a written report, and getting
161079 - a printed form saying to talk to the doctor.
161081 - ..
161082 - Kaiser's printed document continues...
161083 -
161084 - How can you care for yourself at home?
161085 -
161086 - 1. Have another adult watch you closely for the next 24 hours.
161087 - That person should check for signs that your head injury is
161088 - getting worse. (See the "When should you call..." sections
161089 - below.)
161091 - ..
161092 - 2. Put a cold, moist towel onto the sore area to reduce
161093 - swelling.
161095 - ..
161096 - 3. Take acetaminophen (Tylenol) as directed to releive pain.
161097 - Do not take anyother medicines, unless your doctor or other
161098 - health care professional orders them.
161100 - ..
161101 - 4. You may sleep. If your doctor or other health care
161102 - professional tells you to, have another adult check you at
161103 - the suggested times to make sure you are able to wake up,
161104 - recognize the otehr adult, and act normally.
161106 - ..
161107 - 5. Take it easy for the next few days or longer if you are not
161108 - feeling well.
161110 - ..
161111 - 6. Do not drink any alcohol for at leas the next 24 hours.
161113 - ..
161114 - Follow-up care is a key part of your treatment and safety. As
161115 - a partner in your health care, you can do things like keep all
161116 - scheduled visits, be sure you know the resutls of all tests
161117 - and labs ordered as part of your care, and keep an up-to-date
161118 - personal list of the medicines you are taking. Know how to
161119 - contact us between visits, and call your doctor or other
161120 - health care professional if you have signs that you are having
161121 - problems.
161123 - ..
161124 - What is postconcussion syndrome?
161126 - ..
161127 - If you have had a mild concussion, you may have a mild headache
161128 - or just feel "not quite right." These symptoms are common
161129 - after a head injury and usually go away on their own. It can
161130 - take a few days to 4 weeks for the symptoms to fade.
161131 - Occasionally, after a concussion you may feel as if you not
161132 - functioning as well as you did before the injury, and you may
161133 - have new symptoms. This is called postconcussion syndrome.
161135 - ..
161136 - You may...
161137 -
161138 - 1. Have changes in your ability to solve problems, think,
161139 - concentrate, or remember.
161141 - ..
161142 - 2. Headaches.
161144 - ..
161145 - 3. Changes in sleep patterns, such as not being able to sleep
161146 - or sleeping all the time.
161148 - ..
161149 - 4. Personality changes.
161151 - ..
161152 - 5. Lack of interest in daily activities.
161154 - ..
161155 - 6. Become easily angered, or anxious for no clear reason.
161157 - ..
161158 - 7. Changes in sex drive.
161160 - ..
161161 - 8. Lose sense of taste or smell.
161163 - ..
161164 - 9. Feel dizzy, lightheaded, or unsteady, cannot stnad up or
161165 - walk.
161167 - ..
161168 - It may take several weeks to many months for these symptoms to
161169 - go away, but make sure to mention any new symptoms to your
161170 - doctor or other health care professional.
161172 - ..
161173 - How does someone suffering loss of memory, per above, ref SDS 0 T66H,
161174 - remember to tell the doctor anything?
161176 - ..
161177 - Kaiser's Special Instructions document continues...
161178 -
161179 - When should you call 911?
161181 - ..
161182 - If you think you are experiencing a medical emergency, call 911
161183 - immediately or seek other emergency services. Examples of
161184 - symptoms that may be an emergency include...
161185 -
161186 - 1. You have twitching, jerking, or a siezure.
161187 - 2. You pass out (lose consciousness).
161189 - ..
161190 - When should you call your doctor or other health care
161191 - professional?
161192 -
161193 - 1. You continue to vomit after 2 hours, or you have new
161194 - vomitting.
161196 - ..
161197 - 2. You have a new watery (not like mucus from a cold) or
161198 - bloody fluid coming from your nose or ears.
161200 - ..
161201 - 3. The person checking you has a hard time waking you.
161203 - ..
161204 - 4. You are confused or cannot think clearly.
161206 - ..
161207 - 5. You have trouble walking or talking.
161209 - ..
161210 - 6. Your headaches get worse.
161212 - ..
161213 - 7. You have questions or concerns about any other new
161214 - symptoms.
161216 - ..
161217 - How can you learn more about head injuries?
161218 -
161219 - 1. Log on: members.kp.org. Search for head injury in the
161220 - Health encyclopedia.
161222 - ..
161223 - 2. Look in: Kaiser Permanente Healthwise Handbook.
161225 - ..
161226 - The Healthwise Handbook was reviewed on 990625. ref SDS 1 3822
161228 - ..
161229 - Kaiser's Special Instructions document continues...
161230 -
161231 - Your Kaiser Permanente Care Instructions adapted from
161232 - Healthwise, Incorporated c 2006. All rights reserved.
161233 -
161234 - Strains and sprains.
161236 - ..
161237 - Your Kaiser Permanente Care Instructions
161239 - ..
161240 - A strain happens when you overstretch, or pull, a muscle. A
161241 - sprain occurs when you stretch or tea a ligament -- a touch
161242 - tissue that conencts one bone to another. These problems can
161243 - happen when you exercise or lift something or when you are in
161244 - an accident.
161246 - ..
161247 - Rest and other home care help strains and sprains heal.
161249 - ..
161250 - How can you care for yourself at home?
161251 -
161252 - 1. Rest the strained or sprained area.
161253 -
161254 - 2. Put ice or cold pack on the sore area for 10 to 15 minutes
161255 - at a time to stop swelling. Try this every 1 to 2 hours
161256 - for 3 days (when you are awake) or until the swelling goes
161257 - down. Put a thin cloth between the ice pack and your skin.
161259 - ..
161260 - Prop up a sore arm or leg on a pillow when you ide it or
161261 - anytime you sit or lie down. Try to keep it above the
161262 - level of your heart. This will reduce swelling.
161264 - ..
161265 - Take pain medicines exactly as directed.
161266 -
161267 - a. If the doctor or other clinician gave you a
161268 - prescription medicine for pain, take it as prescribed.
161270 - ..
161271 - b. If you are not taking a prescription pain medicine,
161272 - take an over the counter medicine, such as ibuprofen
161273 - (Advil or Motrin) or naproxen (Aleve), as needed to
161274 - reduce pain and swelling. read and follow all
161275 - instructions on the label. No one younger than 20
161276 - should take aspirin. It has been linked to Reye's
161277 - syndrome, a serious illness.
161279 - ..
161280 - This aligns with the doctor's instructions, per above, saying Millie
161281 - should take Motrin for pain and to control inflammation. ref SDS 0
161282 - 5O8O
161283 -
161284 - [On 080204 Gloria in Kaiser Coagulation Control Clinic
161285 - recommended patients taking Coumadin, use Tylenol to control
161286 - pain rather than Motrin, because Motrin can cause internal
161287 - bleeding, which Coumadin can make life threatening. ref SDS 24
161288 - S65I
161290 - ..
161291 - [On 080226 Millie's letter confirms telecon notifying
161292 - Kaiser Coagulation Control Department of bruising from
161293 - fall on 080125. ref SDS 26 S13Y
161295 - ..
161296 - Kaiser's Special Instructions document continues...
161297 -
161298 - c. Do Not take two or more pain medicines at the same time
161299 - unless the doctor other clinician told you to.
161301 - ..
161302 - 3. Do exercises as directed by your doctor or other
161303 - clinician.
161305 - ..
161306 - 4. Return to your usual level of activity slowly.
161308 - ..
161309 - Follow-up care is a key part of your treatment and safety. As
161310 - a partner in your heal care, you can do things like keep all
161311 - scheduled visits, be sure you know the results of all tests and
161312 - labs ordered as part of your care, and keep an up-to-date
161313 - personal list of the medicines you are taking. Know how to
161314 - contact us between visits, and call your doctor or other
161315 - clinician if you have signs that you are having problems.
161317 - ..
161318 - When should you call 911?
161319 -
161320 - 1. You have sudden chest pain and shortness of breath, or you
161321 - cough up blood.
161323 - ..
161324 - When should call Kaiser Permanente?
161325 -
161326 - 1. You have increased or severe pain.
161327 -
161328 - 2. Your foot or hand is cool or pale or changes color.
161329 -
161330 - You have tingling or numbness in your foot or hand.
161332 - ..
161333 - Your cast or splint feels too tight.
161335 - ..
161336 - You have signs of a blood clot, such as...
161337 -
161338 - a. Pain in your calf, back of the knee, thigh, or groin.
161339 -
161340 - b. Redness and swellin your your leg or groin.
161342 - ..
161343 - 3. You cannot move the sprained or strained part of yor body.
161345 - ..
161346 - 4. You cannot put weight on a joint, or ti feels unsteady
161347 - when you walk.
161349 - ..
161350 - 5. Your painis not improving after 2 days home treatment.
161352 - ..
161353 - How can you learn more about strains and sprains?
161354 -
161355 - 1. Log on: members.kp.org. Search for back problems and
161356 - injuries, arm injuries, or leg injuries.
161357 -
161358 - 2. Look in: Kaiser Permanente Healthwise Handbook.
161360 - ..
161361 - Care instructions adapted by Kaiser Permanente from healthwise,
161362 - Incorporated c 2006. All rights reserved.
161363 -
161364 -
161365 -
161366 -
161367 -
161368 -
161369 -
161370 -
161371 -
161372 -
1614 -