Right SVC is present in the majority of people with left SVC. Ketoacidosis is a complicated physiological state resulting from fatty acid and amino acid degradation often associated with type 1 diabetics. Some limited data shows corticosteroids as a possible treatment for neuroinvasive disease. Supplies include: ChloraPrep, Leur Lock Caps, sterile gloves, sterile gowns, saline flushes, dressing kits, chlorhexidine BioPatches, ultrasound gel packets, sterile ultrasound probe covers, and razors. The forth topic From Burnout to Engagement was delivered 9 times. The patient was indulged in a conversation with her daughter when all of a sudden, she became silent. WebHCA, North Texas Division is comprised of 9 premier Medical Centers located in the Dallas/Fort Worth metroplex. However, unlike the others, the case presented here was quite severe and progressed rapidly, unfortunately leading to a poor outcome. Additionally, the pregnancy USS revealed a non-viable fetus, concluding that a spontaneous abortion was inevitable. You can find all jobs here. Currently a quality improvement project is underway to implements several of these measures. Key areas of improvement are in those of compliance; namely, the implementation of a dedicated central line cart and a reminder check list to help staff. Int J Dermatol. The second topic Faculty Wellness was delivered 10 times. CLL/SLL presenting as bilateral tonsillar enlargement is quite rare and the majority of cases described were incidental findings or presented as obstructive sleep apnea. Unfortunately, these therapies are not always well tolerated and many patients are forced to discontinue the medication due to side effects. I am having a problem logging in to see or create my job application, Log in or retrieve your username and password. After tonsillar biopsy confirmed diagnosis and ruled out transformation, patient was started on CHOP chemotherapy. Abnormality of the SVC has implications for electrophysiology procedures and ICE/CT and cMRI imaging are helpful in delineating the anatomy. Simply choose your specialty and location. SGLT2i has become popular for its antihyperglycemic, cardiovascular, and renal health benefits; however, physicians should be cautious to prescribe this medication when the patient is on a low-carbohydrate diet. This unique case has several important teaching points ranging from hematology/oncology, critical care, infectious disease, surgery, and laboratory science. WebHCA Gulf Coast Division 3737 Buffalo Speedway Suite 1400 Houston, TX 77098 Telephone: (713) 852-1500 Quick Links About Us --About HCA Gulf Coast --Mission and It Wasnt a Duck: A Case of the Misdiagnosis of Ketoacidosis, Lesion Size Inclusion on Dermatopathology Requisition Forms: a Quality Improvement Project, Low-grade Adenosquamous Carcinoma of the Breast in a Pregnant Patient: Case Report and Literature Review, Monitoring Concordance in the Management of Transfusing Blood Components in Cirrhotic Patients for Paracentesis with Evidence-Based Guidelines, Outpatient Breast Cancer Screening Documentation, PHQ -9 Utilization in the Primary Care Setting, Platelets in Preeclamptic Pregnancies Fail to Exhibit the Decrease in Mitochondrial Oxygen Consumption Rate Seen in Normal Pregnancies, Post-Thrombotic Syndrome: Assessing Medical City Weatherford Resident Physicians Knowledge in Diagnosis, Treatment, and Prevention, Presentations of Tumor Recurrence of Non-Melanoma Skin Cancer After Treatment with Low-Energy Superficial Radiation Therapy, Rare Presentation of Primary Malignant Peripheral Nerve Sheath Tumor of the Femur in Neurofibromatosis-1, Retrospective Review of Adverse Events Following Treatment of Non-Melanoma Skin Cancer with Low-Energy Superficial Radiation Therapy, The Domino Effect: Spontaneous Abortions as a Sequela of Eisenmenger Syndrome, West Nile Virus Encephalitis with Status Epilepticus Treated with High-Dose Steroids: A Case Study. Here, we present a case of a 40-year-old male with NF1 who presented with a giant MPNST that originated in the right proximal femur. The patient had significant improvement in symptoms was discharged after one day of hospitalization. As part of the Case Manager Float Pool team, you will help support the following hospitals: Alliance, Arlington, Fort Worth, Las Colinas, North Hills, and Weatherford. Follow. Leverage your professional network, and get hired. WebContact Us . About | Patient was subsequently treated with eight weeks of intravenous cefazolin and gentamicin without any complications. HCA Houston Healthcare Mainland has been an integral part of Galveston County for more Accessibility Statement. 1. Sub-specialty preferred. Suite 2000 Dallas, TX 75240 Physician Referral: (844) 671-4204 Quick Links About Us --Community Impact --Mission & Values - Accessibility Statement. Among NF1 patients, the risk of developing MNPSTs is approximately 8-13% over a lifetime. Repeat resident wellness surveys will be administered to estimate the effect of these interventions. She had a head CT performed which showed lesions in the right caudate nucleus and putamen consistent with HCHB syndrome. The mass was sent for pathology, which confirmed an organized thrombus. Current employees are encouraged to apply through our internal career site, internalcareers.hcahealthcare.com. Five different topics were presented. Operative findings revealed a loop of jejunum that was adhered down to the anterior pelvis wall along a previous peritoneal flap dissection. Dermatological Reviews. See more information about employee benefits. You've come to the right place. Conclusion: The intervention in this study successfully increased the rate of reporting lesion diameters on RFs from an academic outpatient dermatology clinic, demonstrating the importance of education and reinforcement in improving quality. One should have a high index of suspicion of Capnocytophaga if a patient presents with septic shock, has a history of dog bite, has a rash consistent with livedo racemosa, and slow-growing gram-negative intracellular rods on peripheral blood smear. Due to abnormal cardiac anatomy and the inability to perform a transseptal puncture, AF ablation was not performed. Masters Degree is preferred. Total Papers Total Downloads Downloads in the past year. Only healthcare system in North Texas with an adult and childrens hospital on the same campus. Conclusion: Treatment complications were rare, and all were expected complications of radiation therapy. Medical City Healthcare is the only healthcare system in North Texas with an adult and childrens hospital on the same campus. 6565 N Macarthur Blvd Ste 350, Irving, TX 75039. Five different topics were presented. Introduction Most clinicians have heard the old adage: if it looks like a duck, walks like a duck, and quacks like a duck, its a duck. The patient was discharged on Eliquis given the development of stroke on warfarin. Therefore, the USPSTF recommends screening of women who are 50-74 years of age via mammography at average risk of breast cancer every two years. Must be willing to float between designated facilities in the pod you are hired into. A lumbar puncture was performed, showing findings consistent with a viral encephalitis. Long-term efficacy results from Phase 3 are yet to be reported. Patient was diagnosed with severe sepsis with hypotension due to unknown source and admitted for further workup. If you are contacted by anyone requesting payment from you to get a job with HCA Healthcare, please dont respond. It is often antineutrophil cytoplasmic antibody (ANCA) positive. We tested the hypothesis that platelet mitochondria display functional alterations in preeclampsia. Jul 25 2017;5(4):521-525. doi:10.3889/oamjms.2017.122 3. BACKGROUND/INTRODUCTION: Faculty development is an important component for ACGME accreditation of residency programs. Two different graduate medical education programs developed a survey to measure resident wellness; the survey includes parameters regarding burnout, depression, personality, optimism, life satisfaction, and social desirability. We are a new Multispecialty Surgery Center encompassing 23,000 SF with 6 ORs, 2 procedure rooms located on the 1st floor of new MOB on HCA North Cypress campus opening at the end of October. The diagnosis was carried forward for several encounters despite a normal hemoglobin A1C and hypoglycemia with insulin administration. This case report discusses a 55-year-old female patient who presented with altered mental status. Management is typically with supportive care. She was treated with and discharged on insulin each visit. CONCLUSION/DISCUSSION: Physician In Training delivered faculty development is an original, innovative model that can increase education. May 2007;46(5):453-9. doi:10.1111/j.1365-4632.2006.03108.x 5. Her respiratory status ultimately continued to decline while on noninvasive ventilation with Bipap and required intubation. > A combination is recommended postoperatively. The intervention group had a statistically significant increase in reporting rate compared to the control group not receiving the intervention (1.73%, 5/289, chi-squared test, p < 0.001). Nearly half of all physicians experience burnout. Other clinical findings include nephritis presentation on urine analysis with proteinuria, micro and macroscopic hematuria, red blood cells, dysmorphic RBC and RBC casts. Find the location nearest you. It is characterized by its clinical indolence and low-grade cytomorphology. UDS was positive for THC, UA was positive for blood, protein and few bacteria. Prolonged bed rest, continuous oxygen therapy, and anticoagulation under hemodynamic observation can positively influence maternal and fetal outcomes. WebNorth Cypress Surgery Center is located in Houston, Texas. Through the following programs, employees within our facility have the opportunity to obtain a higher level of education, and be well prepared for their roles in our hospital. Central line associated blood stream infections (CLABSI) impart both a significant increase in mortality but also a substantial financial burden onto hospitals. Pregnancy termination is typically advised because spontaneous pregnancy loss/perinatal morbidity are about 30% and maternal mortality for women with ES is reported to be 30-50%. Case Description: Patient is a 47-year-old male with a past medical history of alcohol and methamphetamine abuse who presented to the hospital for unresolved facial droop. This rare presentation of CLL/SLL after Ibrutinib discontinuation includes the management of a critical upper airway obstruction and neoplastic fever, reminder of the laboratory error caused by severe leukocytosis, and how to recognize and help prevent tumor lysis syndrome. This created an internal hernia with multiple loops of small bowel that were herniated underneath. No right-sided SVC was identifiable with the inability to visualize superior aspect of interatrial septum and pulmonary veins. This study aimed to increase the rate of reporting lesion diameters on RFs from an academic outpatient dermatology clinic to greater than 65% through education, reinforcement, and evaluation. Data on CLABSI rates are is still pending but anecdotally the carts have helped cut down on procedural preparation time. Due to the discordant clinical findings, both biopsies were sent to Weill Cornell Medicine for histopathological review. Transvaginal ultrasound revealed the presence of a left ovarian cyst and lack of arterial blood flow to the left ovary, indicating the possibility of a left ovarian torsion. An ascending aortic arch thrombus (ACT) is a rare finding in an anatomically normal aorta. Although the incidence of cancer recurrence after superficial radiation therapy is low, relatively little is known regarding predictive patterns. Printing is not supported at the primary Gallery Thumbnail page. She has had further hospitalizations, after initial evaluation, for poor glycemic control and repeat head CT imaging has continued to show right basal ganglia lesions. Education was given to all residents and nurses responsible for the referral process and on the importance of the correct implementation and recording of a successful mammogram referral. 1. WebNorth Texas. To obtain a certified copy of your Birth Certificate please contact your state or local Vital Statistics Office. In Phase 2, after the intervention, there was a statistically significant reporting rate increase to 49.71% (85/171) in the intervention group (chi-squared test, p < 0.001). 20 Wall Street analysts have issued twelve-month price targets for HCA Healthcare's stock. 10 Delivering content that is convenient and valuable to the faculty can be challenging. Sepsis workup was initiated, and empiric antibiotics were started. Discussion: Bells Palsy presents with a sudden onset of unilateral facial weakness. On the second night of hospitalization, patient developed a fever of 102.2 degrees Fahrenheit. Immune complexes RPGN associated with immune complexes in the glomeruli such as IgA deposits, antistreptococcal antibodies and subepithelial humps, and antinuclear antibodies and subepithelial deposits in lupus nephritis. Multiple episodes of large volume bloody diarrhea is typically the major presenting symptom of STEC dysentery. Stephen Shey, Alejandro Espinosa-Tello, and Amnah Andrabi. 8,9 Beyond the individual faculty, there can be system wide cultural shifts supportive of scholarly teaching. Out of 341 individual cases of malignancy, four were suspected of recurrence during follow-up visits. Case Presentation A 66-year-old female with past medical history of ESRD initially presented to the emergency room complaining of shortness of breath for the past few days. Complications were defined as adverse events within the treatment site persisting beyond the treatment period. Certification in area of specialty preferred. Its an organization whose scale enables caregivers to deliver great outcomes for patients and gives our colleagues unparalleled opportunities to learn and grow. This is a report of a 36-year-old female who presented with severe, acute onset pelvic pain and prominent bruising on her left groin area following intercourse. Our QI project identified a major gap between our clinical practices, in this case use of the PHQ-9, and the clinical informatics that were being reported. Malignant peripheral nerve sheath tumors (MPNSTs) are rare sarcomas, most commonly seen in patients with Neurofibromatosis type 1 (NF1), that are characterized as aggressive with high rate of local recurrence. Introduction and Case Presentation: We report an unusual case of an adult midgut volvulus presenting first as a transverse colon volvulus. If diagnosed early on, patient can be treated with drainage of the pericardium and directed antimicrobial therapy before complications such as cardiac tamponade or constrictive pericarditis can arise. In the preceding five months, she was admitted three times with similar symptoms and was diagnosed with diabetic ketoacidosis. We are committed to each other because when we join together, our patients are cared for in themost compassionate way. A single intervention was conducted on February 4, 2022 to educate the authors on societal guidelines for reporting lesion diameters on RFs. WebHCA Healthcare One Park Plaza Nashville, TN 37203. Hemichorea-hemiballismus (HCHB) syndrome is a syndrome characterized by choreic movements which are irregular, nonrepetitive, and random movements and ballismus which are spontaneous, violent movements. Faculty who had never completed faculty development participated for the first time. Serving Houston and South Texas, HCA Gulf Coast Division is comprised of 16 hospitals, plus freestanding ERs, urgent care centers, surgery centers, physician practices, womens health clinics, imaging centers, and more. You will have the opportunity to float to multiple facilities, as assignments are split by location, East or West. Repeat CT head without contrast and MRI brain w/wo contrast were unremarkable. 41yo M with PMHx significant for Von Gierke type 1a, HFrEF complicated by VT s/p ICD, HTN who presented for complaints of continued SOB with new muscle soreness. Because EuDKA is uncommon, delayed diagnosis and treatment can lead to other complications and prolonged hospitalization. Top three weaknesses were as follows: Feeling of connection to work; feeling that ones work makes the world a better place; feeling eager to come back to work tomorrow. Continuous EEG showed frequent seizures and other epileptiform discharges. At the time of post operative evaluation, the patient was without any recurring symptoms. Introduction: COVID-19 has been identified as primarily a respiratory illness, however, with its clinical manifestation of involvement with multiple organs, it is now considered a systemic illness. It's the foundation of our culture; how we focus on safety, involvement, and voice for all our people. His lengthy hospital course significant for severe leukocytosis (max WBC 439), pseudohyperkalemia, neoplastic fever, hypotension requiring vasopressors, and concern for tumor lysis syndrome. We are a part of HCA Healthcare, one of the nations leading providers of healthcare services with 185 hospitals and 1,800 sites of care, including surgery centers, free standing emergency rooms, urgent care centers and physician clinics in 21 states and the United Kingdom. HCA Healthcare declared a quarterly dividend on Friday, January 27th. Shareholders of record on Friday, March 17th will be paid a dividend of $0.60 per share on Friday, March 31st. This represents a $2.40 annualized dividend and a yield of 0.91%. The ex-dividend date of this dividend is Thursday, March 16th. The query was escalated multiple times until it was discovered that Centers for Medicare and Medicaid Services (CMS) discontinued QM 371. We are a part of HCA Healthcare. In particular, it also can elicit a broad spectrum of neurological symptoms. Most patients will classically present with a constellation of symptoms that correspond to pancytopenia such as fatigue, easy bruising, bleeding, dizziness, weakness, or recurrent infections. Learning Points: This case conveys that a volvulus can be something ephemeral that may resolve after showing characteristic signs of its presence in imaging and causing its characteristic symptoms in patients. Measured beta-hCG was not in range with 9-weeks of pregnancy. Ten Hospitals Nationally Recognized for Safety by The Leapfrog Group 2022, Current Healthcare Provider BLS, ACLS and NRP (for NICU only) issued by the American Heart Association required. However, no schistocytes were seen on peripheral smear, therefore HUS was not diagnosed. 1-3 There are multiple strategies for faculty development with methods including workshops, lunch-ins, and online modules. Pre-ablation CT chest was not performed as the patients baseline creatinine was 1.4 mg/dl. Von Gierke disease is an inherited Glycogen Storage disease - type 1 resulting from deficiencies in the specific enzymes glucose 6 phosphatase(1a), and/or glucose 6 phosphate translocase(1b) glycogen metabolism pathway. Demographic information and medical history related to the population were analyzed as part of the data set. No other evidence was identified of any small bowel pathology that could have caused any of the patients symptoms. HCA HealthcareOne Park PlazaNashville, TN 37203, Telephone: (844) 422-5627 option 1(844) 422-5627 option 1. He denied any recent travel history, illicit drug use, animal bites, allergies, sick contacts, new sexual partners, family history of autoimmune diseases, changes in diet, or recent occupational or environmental exposures. Due to no significant improvement, the patient was started on high dose intravenous corticosteroids. The patient was given Bactrim and Keflex to cover for possible infectious etiology as well as the possibility of cellulitis. We will measure resident knowledge through a short survey/assessment administered before and after the presentation. HCHB syndrome associated with uncontrolled diabetes is also referred to as diabetic striatopathy and is characterized by poor glycemic control, unilateral striatal hyperdensity on CT imaging, and contralateral choreic movements. Presented here is a case of HCHB syndrome initially seen on imaging and later correlated with physical examination. Here we discuss this rare case in detail. The policy applies to all terms and conditions of employment including, but not limited to, hiring, placement, promotion, termination, layoff, transfer, leaves or absence, compensation and training.Equal Employment Opportunity poster. Diabetic, alcoholic, and starvation ketoacidosis may present similarly. BACKGROUND/INTRODUCTION: Faculty development is an important component for ACGME accreditation of residency programs. WebWith the resources and strength of HCA Healthcare, including 186 hospitals in the United States and England, Medical City Healthcare is one of the North Texas regions largest What is the application process for Current Employees? WebNorth Texas Research Forum 2023. New Hca North Texas Division jobs added daily. 3,4 If resident physicians can deliver effective convenient faculty development programs then faculty and resident physicians would both grow as teachers. Jun 2021;9(1):153-166. doi:10.1007/s40487-021-00138-4, Riddhiben Patel, Anas Hamadeh, and Senthil Thambidorai. She was soon able to be extubated and discharged to a rehab facility. I am a physician interested in HCA employment opportunities. The infectious workup eventually revealed that the patient had West Nile virus infection. Committed to the care and improvement of human life, Medical City Healthcare strives to deliver excellence always providing the highest quality, cost-effective healthcare in the communities it serves. 1-3 There are multiple strategies for faculty development with methods including workshops, lunch-ins, and online modules. The developed protocol was used within the Family Medicine outpatient clinic sites at Grand Prairie, North Hills, and Denton to increase screening compliance. Antidopaminergic medications may be used to control the choreic movements of diabetic striatopathy; however, the mainstay of treatment is glycemic control, most commonly with insulin therapy. Akshaj Pole, Danielle Ford, and Elizabeth Pollard. Euglycemic diabetic ketoacidosis (EuDKA) is a rare complication of type 2 diabetes mellitus (T2DM) characterized by normoglycemia in the presence of anion gap metabolic acidosis and blood ketone. Residents were additionally tracked on how many patients they appropriately referred for screening. No evidence of AFib activity on telemetry. A pericardial window was performed which drained 700 mL of purulent fluid. I am a physician seeking privileges with an HCA facility. The patient underwent exploratory laparotomy. These results would suggest that our target audience will be more conscience of preventing DVT; as well as, treating patients appropriately when they present with PTS. I am experiencing technical problems. Patient required fiberoptic nasotracheal intubation. Mary DaCosta, Evelyn Chicas, Kiana Clem, and Shelby Collymore. The tumor was ER low positive, PR positive, and HER2 negative. Patient was seen at the emergency department with symptoms of left-sided eyelid droop and difficulty swallowing two days prior. In a matter of 4 months, the patient had a rapid progression with metastatic disease to the brain and lungs. Early source control through the form of early foci identification, obtaining serial blood cultures, decolonization and hygiene measures, appropriate antibiotic stewardship are used to eradicate this bacteria and prevent its spread. View contact profiles from HCA Healthcare Popular Searches HCA I have a disability and require assistance with the online application. Crucially, her blood ketone and glucose levels normalized without insulin but with the initiation of a dextrose and water infusion and IV thiamine. Our educational presentation was given on Sept 1st at the start of the reporting period for QM 371 and included screen shots depicting the workflow for inputting the PHQ-9 into the eCW smart form. Int High dose corticosteroids were found to be very effective for the management of WNV neuroinvasive disease in this case. Its an organization whose scale enables caregivers to deliver great outcomes for patients and gives our colleagues unparalleled opportunities to learn and grow. The left SVC almost always empties into the right atrium via an expanded coronary sinus. 2023;3(6):409-417. The project involved implementation of a dedicated line cart at MCNH Hospital. McGregor S, Minni J, Herold D. Superficial Radiation Therapy for the Treatment of Nonmelanoma Skin Cancers. The patient was evaluated for aortic valve replacement. Methods: This quality improvement project retrospectively and prospectively analyzed the inclusion rate of lesion diameters on dermatopathology RFs from a single institution. 3. However, symptoms reappeared two days later and now with right-sided facial droop along with dysphagia,and left sided extremities with weakness/tingling sensation. We are a new Multispecialty Surgery Center encompassing 23,000 SF with 6 ORs, 2 procedure rooms located on the 1st floor of new MOB on HCA North Cypress campus opening at the end of October. CTS and hematology were consulted. Dermatological Reviews. HCA Healthcare includes 185 hospitals in the United States and England. This case illustrates that a rare disorder like Fahrs syndrome has a similar presentation to various other neurological diseases but no etiological agent has been established. There is limited evidence on optimal management of an ACT. High-frequency ultrasound image-guided SRT is a well-tolerated treatment for non-melanoma skin cancer. The patient was then started on steroids, cefazolin and given naproxen for pain. A 401k (100% annual match from 3% to 9% of pay based on years of service). WebAmbulatory Services Division is a growth-oriented business sector of HCA Healthcare, encompassing 140+ surgery centers across 16 states with 3,200 physician partners. Hairy Cell Leukemia is a rare leukemia seen with the classic triad of splenomegaly, pancytopenia, and hairy appearing leukemic b cells in the bone marrow. The first topic "Teaching House Staff Safely During the COVID19 Era was delivered 8 times. How can I get assistance? The hallmark to distinguish it from central pathology is the involvement of the forehead. References: 1. This project sought to assess utilization of the PHQ-9 in our clinical practice. Using Seahorse respirometry, we analyzed platelets for oxygen consumption (OCR) and extracellular acidification (ECAR) rates, indicators of mitochondrial electron transport and glucose metabolism, respectively. HCA Healthcare is dedicated to giving people a healthier tomorrow. Physicians seeking privileges at one or more HCA facilities should contact the appropriate Physicians Services Office(s). She was also advised to see an endocrinologist for further management of her hypoparathyroidism. RESULTS: Five dermatology residents delivered 45 presentations to 15 faculty individuals over a 30 month period. Results: During Phase 1, 839 skin biopsies were performed, with 594 biopsies meeting the criteria for analysis. After intubation, a bronchoscopy was performed and bacterial and mycobacterial cultures were obtained and showed no growth. 8,9 Beyond the individual faculty, there can be system wide cultural shifts supportive of scholarly teaching. Significant lab values include creatinine 3.39 (baseline normal), hemoglobin of 11.9 and platelet count of 50. Ultimately, she underwent incision and drainage of her surface abscesses, but the GSV had to be excised as well. The patient who developed cutaneous lupus after therapy had no prior history systemic or cutaneous lupus. Immediately after our lecture, residents scored 84%. Phone: (972) 401 Trans-thoracic echocardiogram obtained was consistent with HFrEF with a LVEF 30-35%, severe diffuse hypokinesis, bileaflet aortic valve, severely calcified aortic stenosis with a peak systolic velocity 3.2m/sec, peak systolic gradient 50 mmhg, mean gradient 30 mmhg, and valve area 1.1. The Treatment of Non-Melanoma Skin Cancer with Image-Guided Superficial Radiation Therapy: An Analysis of 2917 Invasive and In Situ Keratinocytic Carcinoma Lesions. Interested in physician and advanced practice provider career opportunities? About | Physicians seeking privileges at one or more HCA facilities should contact the appropriate Physicians Services Office(s). Qualified Candidates: AP/CP board certification is required. Not a single attending declined the faculty development topic. Stool cultures grew Shiga-toxin 1, leading to diagnosis of Shiga-toxin producing E. coli dysentery. Rediscover the reasons you chose healthcare as your career. Dec 2015;8(12):12-4. To reduce the loss of functionality associated with the condition, new therapeutic approaches must be identified and implemented. Enjoy eating at the wide-variety of restaurants one day or spend the day at one of North Texas many parks the next. I am a physician seeking privileges with an HCA facility. However, this data may not represent the true compliance rate, as reports were frequently not attached to the initial screening template order by nursing staff secondary to high clinic staff turnover rates. On arrival, lactic acid was elevated at 5.2, troponin and EKG were not obtained in the ED. The template would be used for patients who are referred for the imaging study, and completed once the patient presented the results of the completed study.
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