RN2premed

Chest pain is a funny thing. There is no way to guess the right answer without at least a basic workup of labs and EKG, and possibly even echocardiogram. An MI in a 23 year old with no medical problems and no drug use is pretty unheard of, but I never say never. In a 23 year old, it could be anxiety, pericardiitis, congenital defect, some sort of toxicity? The drug screen doesn't detect everything either. Maybe he was taking drugs he lied about, or he was given something he didn't know about. Could also be something like dangerously low potassium/sodium or severe dehydration or even overhydration (water intoxication). Could even be musculoskeletal. These are some of the possibilities, but nowhere near a full list of what is going on. What is the family history? Butter has nothing to do with it. What is concerning to me is that his b/p and heartrate are pretty low, he should be admitted for further workup. Even if he is in good health, that heartrate is low even for someone in optimal health at his age.

I have been an ER nurse for a few years, so I'll give you my take, if I'm understanding your question correctly. Basically, treating an infection in the ER without cultures, is usually due to time sensitive needs. If the person come is very sick looking and with high WBC count, there are a few types of infections such as bacterial meningitis, that will kill you fairly quickly if not treated. As you probably know, cultures of any kind will take at least 24 hours. The patient may not have that much time if he is left untreated. This is especially important for very young infants with fever, antibiotics must be started ASAP, we cannot wait for cultures to rule out viral vs. bacterial infection. Low glucose in cerebrospinal fluid can indicate bacterial infection, so broad spectrum antibiotics will be started. Blood cultures are read at 24 hours, but are usually negative, then again for final read at 48 hours. Certain infections will cause specific symptoms and will be treated as such until proven otherwise