Author: James Rowley / Editor: Fiona Mendes / Codes: GP1, GP9, PhC1, PhC2, PhC3, SLO1, SLO7Published: 25/01/2023

You are asked by the triage nurse to see a re-attending patient to assess whether they require any treatment or investigations.

Previous case notes reveal that this patient is a high intensity user of the emergency department, presenting with the same symptoms. All previous investigations have been normal. The triage nurse wonders “if you could just discharge this patient from the front door?”

The patient is a 23-year-old female with severe vomiting and mild abdominal pain. She has been seen in your emergency department nine times over the past six months with the same symptoms. She has no diarrhoea, urinary symptoms or fever.

During the course of these attendances, she has had multiple investigations, including ECGs, blood tests, urinalysis, abdominal CT and ultrasound scans. All of which have been normal. Pregnancy tests are negative. She has previously been admitted under the surgical team, but no cause for her symptoms could be found.

On assessment she is forcefully vomiting and begging you for something to ease her symptoms. She tells you that none of the treatments she has been given in the Emergency Department previously helped with the sickness, but she has come in again today as she feels so dehydrated and unwell.

When you initially came into the cubical to talk to her, she was running hot water over both of her hands and splashing her face as she says hot showers seem to be the only way of controlling her nausea and she is trying to recreate the sensation.

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