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“Patty’s full right now, and Yvonne has a student. Here ya go” she said, plopping the clipboard on the counter top. Alex took it and gave it a glance-38 year old female presented with chest pain that started 5 hours prior to admission. Seen in the ER by Dr. Manu, and given aspirin, morphine, and nitroglycerin for chest pain. EKG given to cardiologist, who read it as ‘nonspecific t wave changes’”. Cardiologist recommended observation, with possible stress test for cardiomyopathy on discharge. Troponin negative x1, but patient will need serial Troponins x2 every few hours and another EKG tonight to watch for ST-elevation.Sounds like I need to keep an eye out for her, Alex thought. Although chest pain was one of the most common presentations to the Emergency Department, it didn’t mean this one couldn’t take a turn for the worse-I’ll have to let the lab know about those Troponin lab orders. Let’s see ... first one was at 2 pm ... so 6 and 10 should be fine ... and the overnight float gets. A river can be described as a system that is continuously changing along its length. Because rivers, and their beds, are in constant change river management is a continuous activity as rivers tend to 'undo' the modifications made by people. Dredged channels silt up, sluice mechanisms deteriorate with age, levees and dams may suffer seepage or catastrophic failure.Depending on the river to define a country can and has been a foolish thing. As an example, farmers in low-lying areas have eaten their dinner and gone to sleep citizens of France and had breakfast in Germany.That Wapole is a Canadian Indian reservation and Harsens is a Native American Reservation ... or should be ... is neither here nor there ... high mucky mucks decided that west is US and east is Canadian ... and that was that.It was just Andrea's luck that both Davids were working in the bay at the end of the long west passage ... currents in Lake St. Clair being what they are ... Clement Shipping lost their barges while.
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