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Fri Jul 9 12:21:36 BST 2004

In a message dated 7/9/2004 12:03:34 AM Eastern Daylight Time, "Jorge Mirabelli" <pandanas at oregonfast.net> writes:

>Thank you .
>Thanks God I read this mail on may way to see an asymptomatic patient,
>with changes in the EKG (elevation ST segment V1 V4). I took a Zofran,
>provide reassurance to the patient and sent him home.
>If this would have happened yesterday I would've been concerned about a
>MI, providing another case for the Vominting syndrome list.
>
>JM
>I guess this was supposed to somehow be analogous to a vertebral artery injury?  Of course, as so typical, no critical analysis of the issue, NOR references to support this stance were provided.  Not that I need to say this, but clearly these are not analogous--the natural history and benefit of investigation and treatment of acute ischemic EKG changes is quite solid--that for "treating" asymptomatic patients with vertebral artery, on the other hand, is virtually nonexistent, and we are talking about imposing significant interventions that put patient at risk.
Now--as I challenged before, and again so typically was not met--if you disagree, please provide the data to support this stance?  The hollow silence that always follows such challenge is mind-boggling, tho not surprising to me.  See above post for confirmation.....
ERF
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>>
>> Here we go again--VOMIT syndrome--an unnecessary test to begin with shows
>> something that never needed to be seen, now simply because it is there you
>> feel something must be done--wrong!  Leave it alone!  How can you improve
>> on a normal patient?  Certainly not by doing all sorts of interventions
>>
>--
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Case advice: Verterbral artery injury