Bouncebacks The Case of a 24-Year-Old Man with Abdominal Pain Bouncebacks appears semimonthly in JUCM. We provide the documentation of an actual patient en- counter, discuss patient safety and risk management principles, and then reveal the patient’s “bounce- back” diagnosis—which often is an unanticipated poor outcome or death. The cases are from the book Bouncebacks! Emergency Department Cases: ED Returns (2006, Ana- dem Publishing, www.anadem.com; also available at www.amazon.com and www.acep.org), which includes 30 case presentations with risk management commentary by Gregory L. Henry, past president of The American College of Emergency Physicians, and discussions by other nationally recognized experts. Ryan Longstreth, MD, FACEP and Michael B. Weinstock, MD O ur goal with the Bouncebacks se- ries is to maximize patient safety and minimize the ur- gent care provider’s medico- legal exposure. As Greg Henry wrote in the forward of our Bouncebacks! book, “The smart doctor is not the one who learns from his own mistakes. The smart doctor is the one who learns from the mistakes of others.” Our case this month in- om volves a young man with s.c ge ma / r I vomiting and diarrhea and ble Sta abdominal pain. This typi- on a B rt © cal urgent care complaint usually is from a self-limit- ing illness, but if the history and physical exam are not able to rule out the “think worst first” diagnosis, then the patient may need to be referred to an emergency department, sent for further testing, or to return to the urgent care for a recheck. w w w. j u c m . c o m In this case, our patient’s complaints at the first visit seem benign, except for several “red flags.” While it is unclear if the ultimate outcome would have been altered if the diagnosis was made sooner, an accurate diagno- sis and recognition of serious illness must be the goal of every encounter. A 24-Year-Old Man with Abdominal Pain Initial Visit (Note: The following is the actual documentation of the providers, including punctuation and spelling errors.) HISTORY OF PRESENT ILLNESS: 24 y/o male c/o abdominal pain and n/v/d x 1 day. States he had a temperature yesterday and began to have stomach upset. States he began throw- ing up this am x 5 and admits to diarrhea today. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J u l y/A u g u s t 2 0 0 8 19